Table of Content

01 October 2024, Volume 42 Issue 19

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The Application of Problem-Based Learning Method Combined with Periodical Study Learning Method in Clinical Medicine Teaching

ZHOU Rong, HOU Li-hua, ZHOU Yang

2024, 42(19):  1-4. 

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Objective To assess the effectiveness of integrating Problem-Based Learning (PBL) and Journal-Based Learning (JBL) in clinical medical education. Methods The study included 50 five-year clinical medicine undergraduates from Jianhu Clinical School of Yangzhou University during the autumn semester of the 2021-2022 academic year. Participants were randomly assigned to either a PBL and JBL combined teaching group (combined group) or a conventional teaching group (control group). Both groups were evaluated at the end of the course on clinical practice thinking ability, literature reading and analysis skills, and student satisfaction through questionnaires. Results The combined group scored significantly higher than the control group in clinical practice thinking ability and literature reading and analysis skills(P<0.05). Furthermore, the combined group reported higher satisfaction scores and an overall higher satisfaction rate compared to the control group(P<0.05). Conclusion The integration of PBL and JBL in clinical medical education significantly enhances students' clinical practice abilities and research exploration skills. This student-centered teaching approach is more readily accepted and recognized by students, demonstrating high effectiveness and satisfaction.

Multiple Regression Model of IRF9, PSMA5 Combined with M1/M2 Polarization Status of Peripheral Blood Macrophages to Predict Rheumatoid Arthritis Progression

GUAN Yue, LI Xin, YANG He-min, XU Si-yu, SHI Li-dong, LIU Yang-yang, KONG Ling-dan, QIN Ying

2024, 42(19):  4-8. 

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Objective To study the predictive value of IRF9 and PSMA5 combined with M1 and M2 macrophage polarization on rheumatoid arthritis (RA) progression. Methods A total of 87 RA patients were divided into active and remission groups based on disease severity. IRF9 and PSMA5 expression, M1 and M2 macrophage proportions, and the M1/M2 ratio were compared. Logistic regression and ROC analysis were used to assess predictive performance. Results Higher expression of IRF9 and PSMA5 was seen in active RA patients. M1/M2 ratio was higher in active RA. Logistic regression identified IRF9, PSMA5, and M1/M2 ratio as RA progression risk factors. AUC values for predicting RA progression were 0.690 for M1/M2, 0.664 for IRF9, and 0.733 for PSMA5. Conclusion M1/M2 polarization, IRF9, and PSMA5 levels were elevated in RA patients and correlated with disease progression. These markers could be valuable for assessing and evaluating RA progression clinically.

Causal Relationship Between Cognitive Performance and Chronic Heart Failure: A Two-Sample Bidirectional Mendelian Randomization Analysis

YU De-hua, CHEN Jing-wei

2024, 42(19):  8-12. 

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Objective Utilize Genome-wide Association Studies (GWAS) summary data to investigate the causal relationship between cognitive performance and chronic heart failure using Mendelian Randomization (MR) method. Methods GWAS data on cognitive ability and chronic heart failure are both from the MR-Base database (http://app.mrbase.org/). After obtaining summary data on exposure and outcome, instrumental variables were selected from the exposure data through correlation analysis, excluding linkage disequilibrium (LD) and weak instrumental variables. Confounding factors were removed on the PhenoScanner website (http://www.phenoscanner.medschl.cam.ac.uk/). The results of this study were obtained using the inverse variance weighted method (IVW), MR-Egger regression, and Weighted Median method, with the inverse variance weighted method as the main method and MR-Egger regression and Weighted Median method as supplementary analytical methods. Cochran's Q test was used to assess heterogeneity in this study, MR-Egger intercept test for pleiotropy, and leave-one-out analysis for sensitivity analysis. Results Through Mendelian Randomization, it was found that an improvement in cognitive ability [OR=0.847, 95%CI (0.759~0.944)] could reduce the risk of chronic heart failure, but there was no substantial evidence that the occurrence of chronic heart failure [OR=0.991, 95%CI (0.905~1.086)] would lead to decreased cognitive ability. Conclusion Mendelian randomization studies have found that improved cognitive ability can reduce the risk of developing chronic heart failure.

Rare Systemic Light-Chain Amyloidosis Involving Multi System Injury: A Case Report

XU Hui-xia, ARu-na, XU Chang-rong, WANG Ying, YUN Sha

2024, 42(19):  13-17. 

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Objective To report and analyze relevant literature on a rare case of systemic light chain amyloidosis involving multiple systems treated in Inner Mongolia People’s Hospital, in order to improve our understanding and diagnosis of diseases. Methods Collect the diagnosis and treatment process of a rare systemic light chain amyloidosis patient with hematuria and edema as the initial symptoms who visited Inner Mongolia Autonomous Region People''s Hospital in April 2023. Results The patient was initially diagnosed with nephrotic syndrome, but the treatment effect was not satisfactory. Finally, multi-disciplinary consultation,a bone marrow biopsy was performed and Congo red staining was performed to confirm the diagnosis of amyloidosis, involving multiple systems. After chemotherapy and renal replacement therapy, the patient improved and was discharged. Conclusion The onset and clinical manifestations of amyloidosis are diverse, difficult to diagnose, and prone to misdiagnosis and missed diagnosis. Once diagnosed, chemotherapy should be administered as soon as possible. For kidney affected patients, combined dialysis is expected to restore kidney function. It is hoped that through case reports, we can improve our understanding of the disease and reduce missed diagnosis and misdiagnosis.

Exploring the Interaction Between Cognition and Gait in Patients with Mild Cognitive Impairment Based on “Physical and Spiritual Unity”

LUO Jia, ZHANG Ji-jing, CAI Wei-lin, ZENG Yi

2024, 42(19):  18-21. 

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Maintaining normal life activity and functional performance requires the body to be with the spirit, the body to follow the spirit, and the body to be one with the spirit. As the body exists and the spirit arises, physical weakness leads to mental weakness, and gait disturbance is an independent risk factor for mild cognitive impairment, it can be imagined that people with a weak gait must have impaired qi and blood, and insufficient essence and fluids, which in turn leads to cognitive decline and the onset of dementia. The brain is the master of God, the spirit is the master of the body, the spirit dominates the functional activities of the internal organs and the operation of the qi, blood, fluid and essence, spiritual damage, damage to the integrity of the structural network of the MCI cerebral cortex and other structures will lead to damage to the body, resulting in gait disorders. Based on the theory of the unity of body and spirit, the interactive relationship between cognition and walking in MCI patients is explored, emphasizing the co-regulation of “body and spirit”, and providing a theoretical basis for the diagnosis and treatment of MCI.

Clinical Study of Internal Fixation with Palmar Cut-and-Replace Locking Splint Versus Non-Operative Treatment of Distal Radius Fractures in the Elderly

YU Yong-zhen

2024, 42(19):  43-47. 

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Objective To investigate the clinical efficacy of palmar cut-and-replace locking splint internal fixation versus non-operative treatment of distal radius fractures in the elderly. Methods Eighty cases of elderly patients with distal radius fracture were collected from January 2022 to October 2023 in the Yili Friendship Kangmian Hospital, and were grouped according to different treatment plans (45 cases in the surgical group received palmar incision and reduction locking splint internal fixation, and 35 cases in the non-surgical group received manipulation and external fixation with a small splint), and were compared to the two groups' wrist function (assessed by the wrist function rating scale), fracture site and ulnar wrist pain score (assessed by the visual analogue rating scale), time to appearance of bone crust and disappearance of fracture line, and occurrence of complications 6 months after treatment. The two groups were compared in terms of wrist function (assessed by wrist function rating scale), pain scores at the fracture site and ulnar side of the wrist (assessed by visual analogue rating scale), time to the appearance of bone scab and disappearance of the fracture line, and occurrence of complications at 6 months after treatment. Results There was no statistically significant difference (P>0.05) in the comparison of the excellent rate of wrist joint function (93.33%, 42/45; 88.57%, 31/35) between the two groups at the 6th month after treatment. There was no significant difference between the fracture site and ulnar wrist pain scores of the two groups before treatment (P>0.05), and the above scores decreased significantly in both groups 6 months after treatment (P<0.05), and the fracture site and ulnar wrist pain scores of the surgical group were lower than those of the non-surgical group (P<0.05). The time between the appearance of bone scab and the disappearance of the fracture line was significantly shorter in the surgical group than in the non-surgical group (P <0.05). The total complication rate of the surgical group was 4.44% (2/45) lower than that of the non-surgical group, which was 17.14% (6/35), but no statistically significant difference was seen (P>0.05). Conclusion Metacarpal cut-and-replace locking splint internal fixation for distal radius fracture in the elderly has better efficacy, improves wrist function, and relieves the degree of pain between the fracture site and the ulnar side of the wrist.

Correlation and Prognostic Analysis of Cyclin E, P53, CD44s, CD44v6 and Early Breast Cancer

ZHANG Shu-juan, Munire Muhetaer

2024, 42(19):  51-54. 

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Objective To analyze the correlation and prognostic value of cyclin E, p53, CD44s, CD44v6 proteins in tumor tissues with early breast cancer. Methods From July 2018 to July 2020, 80 cases of early breast cancer patients with clinical stage Ⅰ-Ⅱ in our hospital were selected as the research object, and they were divided into malignant group, and another 80 cases of benign breast cancer patients treated in our hospital in the same period were selected as benign group. The expressions of cyclin E, p53, CD44s, CD44v6 in tumor tissues of the two groups were detected by immunohistochemistry, and the positive rates of the above indicators were compared. The correlation between cyclin E, p53, CD44s, CD44v6 and early breast cancer was analyzed by Spearman correlation analysis. All patients were treated with surgery, and then 80 patients with early breast cancer were followed up for 3 years. According to the follow-up results, the patients were divided into two subgroups, namely, the poor prognosis group (n=25) and the good prognosis group (n=55). The general clinical characteristics and the positive rates of cyclin E, p53, CD44s and CD44v6 in the two groups were compared, and the predictive value of cyclin E, p53, CD44s and CD44v6 for the prognosis of early breast cancer was analyzed by Logistic regression analysis. Results The positive rates of cyclin E, p53, CD44s and CD44v6 in malignant group were 42.50%, 61.25%, 77.50% and 81.25% respectively, which were significantly higher than those in benign group (1.25%, 5.00%, 10.00% and 12.50%, P<0.05); Spearman correlation analysis showed that cyclin E, p53, CD44s, CD44v6 were positively correlated with early breast cancer (P<0.05); There was no statistically significant difference in menopause, age, pathological type, tumor size and histological differentiation between the good prognosis group and the poor prognosis group (P>0.05). There was statistically significant difference in clinical stage, cyclin E, p53, CD44s, CD44v6 positive number between the good prognosis group and the poor prognosis group (P<0.05); The final Logistic regression analysis showed that the positive expression of cyclin E, p53, CD44s and CD44v6 were the independent factors influencing the prognosis of early breast cancer (P<0.05). Conclusion The expression levels of cyclin E, p53, CD44s and CD44v6 are significantly related to the occurrence and development of breast cancer, and the positive expression of these indicators is an independent predictor of poor prognosis in early breast cancer.

Clinical Research Progress of External Treatment of Traditional Chinese Medicine in the Treatment of Knee Osteoarthritis

LIAN Yi-Feng, XU Hui, BIAN Yan-Qin, WANG Zheng, WANG Zhen

2024, 42(19):  65-68. 

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Knee osteoarthritis (KOA) is one of the common degenerative bone and joint diseases. Its causes are complex, and it has the characteristics of high incidence and high disability rate. External treatment of traditional Chinese medicine is one of the important methods to intervene koa in clinic. It has significant curative effect in relieving pain, improving knee joint mobility, reducing inflammatory reaction and so on. This paper summarizes the relevant research literature of KOA in recent years, and finds that the external treatment methods of traditional Chinese medicine are diverse, often in the form of combined treatment. At present, there are some shortcomings in the related research of traditional Chinese medicine treatment of KOA, such as small sample size, less follow-up, lack of objective evaluation indicators, etc. we should further adopt a more rigorous randomized controlled trial design, and we can clarify the treatment effect by applying evaluation indicators such as pressure pain threshold.

Construction of Self-Management Intervention Program for Patients with Postpartum Stress Urinary Incontinence Based on Health Action Process Orientation Theory

XIA Li-hong, DU Xin-jie, LIU Heng, SHI Yong-ping, YANG Jie, WU Wen-li

2024, 42(19):  73-77. 

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Objective To construct a self-management intervention program for patients with postpartum stress urinary incontinence based on the theory of health action process approach. Methods We systematically searched the literature on PSUI self-management, formed a preliminary intervention draft after discussion with an expert panel, and used the Delphi expert consultation method to construct the final self-management intervention program for postpartum stress urinary incontinence. Results After two rounds of expert consultation, the questionnaire recovery rates were 95% and 100%, the expert authority coefficients were 0.937 and 0.944, and the Kendall’s coefficients were 0.232 and 0.423 (P<0.001), respectively. The final intervention program consisted of 3 primary indicators, 10 secondary indicators, and 20 tertiary indicators. Conclusion The constructed self-management intervention program for patients with postpartum stress urinary incontinence is systematic, specific, practical, and scientifically sound, providing a clinical reference for patient self-management.

Application of Case-Based Learning Combined with Surgery Observation Teaching Method in the Standardized Training of Residents in Department of Painology

YAN Ru-hu, CHENG Ling

2024, 42(19):  78-81. 

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Objective To explore the application value of case-based learning combined with operation observation in standardized training of resident physicians in pain department. Methods A total of 50 residents who received standardized training in the Department of Intervention and Pain, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine From April 2022 to November 2022, they were selected and randomly divided into a control group and an experimental group with 25 people in each group. The control group used traditional teaching methods, while the experimental group adopted the teaching method of case-based learning combined with surgical observation teaching method. After the teaching,the differences in teaching effects were analyzed through theoretical written tests, recognition surveys, and overall satisfaction with teaching methods. Results The theoretical written test scores of the experimental group and the control group were (83.84±4.53) points and (76.28±4.59) points, and the experimental group was higher than the control group (P<0.05). The recognition of teaching mode (stimulating clinical learning interest, improving self-learning efficiency, enhancing clinical thinking ability, promoting theoretical knowledge mastery and willingness to accept this teaching mode) and overall satisfaction with teaching methods were compared in the experimental group, with a higher proportion than the control group (P<0.05). Conclusion The teaching mode of case-based learning combined with surgical observation has obvious advantages in the standardized training and teaching process of pain resident physicians, which can significantly improve the clinical teaching effect and is well received by trainees.

Analysis of Colorectal Cancer Primary Screening Results and Its Risk Factors among Community Residents in Baihedong Street, Liwan District, Guangzhou City, China, 2020-2022

YU Zhe-xiao

2024, 42(19):  84-87. 

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Objective To analyze the results of colorectal cancer primary screening of permanent residents in Baihedong Street, Liwan District, Guangzhou City, 2020-2022, and to explore the risk factors affecting colorectal cancer positivity, so as to provide a basis for clinical prevention and treatment of colorectal cancer. Methods A total of 1,131 residents participating in colorectal cancer screening in Baihedong Street, Liwan District, Guangzhou City, China, from 2020 to 2022 were selected as the study subjects, and a combination of questionnaires and fecal occult blood tests (FOBTs) was used to conduct the screening as well as correlation analyses of risk factors. Results The initial screening results of 181 residents were positive, with a positive rate of 16.01%, of which 88 (48.6%) were male, 93 (51.4%) were female; 946 residents were negative, with a rate of 83.64%; and 4 cases could not be determined, with a rate of 0.35%.The proportion of patients with a history of chronic constipation, mucous blood stools, chronic cholecystitis, intestinal polyps, chronic appendicitis, and a history of cancer in the group with positive initial screening results was higher than the proportion of patients in the group with negative initial screening results, and the difference was statistically significant (P<0.05).The results of multifactorial analysis revealed that a history of mucous blood stools, a history of intestinal polyps, and a positive FOBT remained risk factors for a positive primary screening result (P<0.05). Conclusion Preliminary colorectal cancer screening results of residents aged 45-74 years in Baihedong Street, Liwan District, Guangzhou City, China, indicate that a history of mucous bloody stools, a history of intestinal polyps, and FOBT positivity are the key risk factors for colorectal cancer,It is suggested that people with such risk factors should undergo more frequent screening and further investigations such as colonoscopy for early diagnosis and treatment and to reduce morbidity.

Investigation and Analysis of the Current Situation of Hospital Infection Management in 262 County and Township Medical Institutions in Yunnan Province

FAN Li, TANG Ting, YUAN Chen-yu, ZHANG Lei

2024, 42(19):  88-91. 

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Objective To understand the current situation of hospital infection management departments in secondary and lower medical institutions in Yunnan Province, and to discuss how to improve the quality of hospital infection management in county and township medical institutions under the background of county-level medical community. Methods A questionnaire survey was conducted to investigate the status quo of hospital infection management departments in 262 county and township medical institutions in Yunnan Province. Results 91.60% of the hospitals have set up independent hospital infection management departments, of which 84.58% belong to the first-level departments, which are directly under the jurisdiction of the president and vice president. Among the full-time staff, 42.74% have a college degree or below, 32.69% have senior professional titles, and 8.40% of the hospitals do not meet the requirement of one full-time staff for every 250 beds actually used. 25.57% of the hospitals established an information monitoring system for nosocomial infection, and the proportion of township health centers participating in various targeted monitoring was lower than that of county-level hospitals, and the difference between the two groups was statistically significant (P<0.05). Conclusion It is suggested that the construction of departments and the training of professional teams should be strengthened to improve the management of hospital infection in county and township medical institutions.

Effect of IKAP Mode on Self-perceived Burden and Cancer related Fatigue in Mammary Cancer Patients Undergoing Chemotherapy

MENG Jing

2024, 42(19):  91-94. 

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Objective To explore the effect of IKAP mode on self-perceived burden and cancer related fatigue in Mammary cancer patients undergoing chemotherapy. Methods A total of 82 Mammary cancer patients admitted to Zaozhuang Municipal Hospital from January 2021 to December 2022 were selected as the research objects.According to the random number table, divided into observation group and control group,41 cases in each group.The control group was given routine intervention mode,the observation group was given IKAP mode.After intervention,the self-perceived burden,cancer-related fatigue and the improvement of quality of life were compared between the two groups. Results Before the intervention, the difference between self-perceived burden and cancer fatigue score between the two groups (P>0.05), the self-perceived burden and cancer fatigue score were lower than that of the control group, with a statistically significant difference (P<0.05).The five scores of patients were higher than those of the control group, which the difference was significant (P<0.05). Conclusion IKAP model can relieve negative emotion,reduce the burden of self-perceived and cancer related fatigue, and improve the quality of life of breast cancer patients.

Analysis of the Application Effect of Positive Feedback Psychological Nursing in Patients with Schizophrenia

WANG Xue, LIU Fang-jie, SONG Xiao-shuang

2024, 42(19):  111-114. 

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Objective To explore the intervention effect of positive feedback psychological nursing on SP(schizophrenia) patients. Methods A total of 98 SP patients from March 2021 to August 2023 who were admitted in Fourth People's Hospital of Liaocheng City were selected, and randomly divided into the intervention group (n=49, positive feedback psychological care) and the control group (n=49, routine psychological care). The psychological status, self-efficacy, shame, and social function in both groups were compared. Results After intervention, Beck Anxiety Inventory(BAI) and Beck Depression Inventory-Ⅱ(BDI-Ⅱ) scores in both groups were decreased, and in comparision of the control group, the intervention group was lower (P<0.05). After intervention, General Self-Efficacy Scale(GSES) scores in both groups were increased (P<0.05), and in comparision of the control group, the intervention group was higher (P<0.05). After intervention, Stigma Scale for Mental Illness(SSMI-C) scores in both groups were decreased (P<0.05), and in comparision of the control group, the intervention group was lower (P<0.05). After intervention, Personal and Social Performance Scale(PSP) scores in both groups were increased (P<0.05), and in comparision of the control group, the intervention group was higher (P<0.05). Conclusion The application of positive feedback psychological care in SP patients can improve their psychological state, reduce shame, enhance self-efficacy and social function.

Effect of Group Pregnancy Health Care Service Model on Blood Sugar Level, Delivery Outcome and Psychological State of Gestational Diabetes Mellitus Patients

WU Xing-yun, HUANG Xiao-fei

2024, 42(19):  118-121. 

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Objective To analyze the influence of group pregnancy health care service mode on blood sugar level, delivery outcome and psychological state of gestational diabetes mellitus patients. Methods A total of 150 pregnant women with gestational diabetes mellitus who filed in The Eighth People's Hospital of Dongguan from January 2021 to January 2022 and planned to give birth were selected as the research object, and were randomly divided into two groups, with 75 patients in each group. The control group received routine pregnancy care service, and the observation group added the intervention of group pregnancy care service mode. Blood glucose levels, anxiety and depression scores before and after intervention were compared between the two groups, and delivery outcomes were compared between the two groups. Results Before intervention, fasting blood glucose, 2h postprandial blood glucose and glycated hemoglobin indexes were not different between the two groups (P>0.05). After intervention, the fasting blood glucose, postprandial 2h blood glucose and glycated haemoglobin indices of the observation group were lower(P<0.05). The natural delivery rate in the observation group was higher(P<0.05). There were no differences in fetal distress, macrosomia, postpartum hemorrhage and hypertension during pregnancy between the two groups (P>0.05). Before intervention, there was no difference in SAS and SDS scores between the two groups (P>0.05). After intervention, the SAS and SDS scores of the observation group were lower(P<0.05). Conclusion The group pregnancy care service model can help to regulate the blood sugar level of gestational diabetes mellitus patients, improve the natural delivery rate, reduce the adverse pregnancy outcome, and help to improve the psychological state of patients, which is of great significance for popularization and use.

The Application Effect of Thoracic Paravertebral Nerve Block Assisted Local Anesthesia in Percutaneous Vertebroplasty in Elderly Patients

NI Hong-yan, KAN Hou-ming, XU Xiang-yang, LI Qian-sheng, WANG Yuan-lin

2024, 42(19):  166-170. 

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Objective Observe the application effect of thoracic paravertebral nerve block assisted local anesthesia in percutaneous vertebroplasty. Methods Sixty patients undergoing percutaneous vertebroplasty admitted to Jiangsu Province Siyang Hospital from June 2021 to August 2022 were selected as the study subjects and randomly divided into an observation group (thoracic paravertebral nerve block supplemented by local anesthesia) and a control group (local anesthesia) using a numerical table method, with 30 patients in each group. Observe the digital scale score (NRS), mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂), Ramsay score, and incidence of adverse reactions in two groups of patients at different time points. Results There was no statistically significant difference in mean arterial pressure (MAP) and heart rate (HR) between the two groups of patients before surgery (T0) and after surgery (T3) (P>0.05). During puncture (T1) and bone cement injection (T2), the MAP and HR of the observation group were lower than those of the control group (P<0.05). There was no statistically significant difference in blood oxygen saturation (SpO2) between the two groups of patients at the four time points T0, T1, T2, and T3 (P>0.05). There was no statistically significant difference in Ramsay score and Numerical Rating Scale (NRS) between the two groups of patients at the end of surgery (T3) (P>0.05). During puncture (T1) and bone cement injection (T2), the Ramsay score and NRS score in the observation group were lower than those in the control group (P<0.05). There were no serious adverse reactions in both groups of patients (P>0.05). Conclusion Patients undergoing percutaneous vertebroplasty can effectively improve intraoperative pain and stabilize their vital signs by using ultrasound-guided thoracic paravertebral nerve block as an auxiliary local anesthesia treatment.

Clinical Efficacy Evaluation of Serum PLA2R Combined with IgG4 Detection in Adult Idiopathic Membranous Nephropathy

BAO Mei-yan, JI Yan-xin

2024, 42(19):  170-173. 

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Objective To investigate the early detection and diagnosis of the expression levels of serum M-type phosphatase A2 receptor (PLA2R) combined with renal tissue IgG4 in adult idiopathic membranous nephropathy, and to explore its significance. MethodForty-two adult patients with idiopathic membranous nephropathy admitted to Qingdao Shibei District Geriatric Hospital (Qingdao Shibei District People's Hospital) from May 2020 to May 2022 were selected as the observation group, while 34 patients with minimal lesions of kidney disease admitted during the same period were selected as control group A and 30 patients with membranous nephropathy were selected as control group B. The observation group was treated with cyclosporin A combined with glucocorticoid. The serum M-type phosphatase A2 receptor (PLA2R) and renal tissue IgG4 levels were compared in several groups of patients. ResultThere were no significant differences in gender, age, disease duration, 24-hour urine protein, serum albumin, blood creatinine, and blood urea levels among the three groups of patients (P>0.05). Compared with control group A and control group B, the observation group had higher PLA2R measurement values and higher positive rates of IgG4 measurement in renal tissue. The difference between the groups was statistically significant (P<0.05). There was no statistically significant difference (P>0.05) in the measurement results of BPLA2R and IgG4 in renal tissue between control group A and control group. The PLA2R measurement value in the observation group was lower after treatment compared to before treatment, and the difference between the groups was statistically significant (P<0.05). Conclusions erum M-type phosphatase A2 receptor (PLA2R) and renal tissue IgG4 show abnormal expression levels in adult patients with idiopathic membranous nephropathy, which is significantly different from that in healthy people and membranous lupus nephritis, which can provide reference for the diagnosis of the disease.

Effects of Different Classification Models on the Clinical Effectiveness of Artificial Intelligence Lung Nodule Screening Systems

LIANG Yu, LI Jun-Lin

2024, 42(19):  173-177. 

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Objective To explore the impact of different classification models on the performance of artificial intelligence (AI) lung nodule screening system, and to select the most suitable classification model for clinical use. Methods A retrospective study was conducted on 117 cases of chest CT plain scan. First, two experts with over 15 years of experience in reading chest CT images developed the gold standard for this study, and a total of 563 lung nodules were annotated. AI lung nodule screening system was used to detect the lung nodules, and the number of lung nodules detected by AI system configured with different classification models was recorded. Model 1 was an independently developed algorithm based on deep neural network, Model 2 was an optimized algorithm based on Model 1 to reduce false positive nodules, and Model 3 was an optimized algorithm based on Model 2 to enhance the sensitivity of ground-glass nodules. By comparing with the gold standard, the number of true positive nodules (TP), false positive nodules (FP) and false negative nodules (FN) detected by AI with different classification models were analyzed, and the corresponding sensitivity, FP/TP value, false positive rate (number of false positive nodules/CT), precision, recall, and F1 score were calculated and compared to explore the most suitable AI lung nodule screening system for clinical work. Chi-square test was used for statistical analysis of ratio indicators, and P<0.05 was considered statistically significant. Results AI Model 1 detected 1 490 nodules, including 505 TP and 985 FP, with 58 FN, and the detection sensitivity was 89.7%. The false positive rate was 8.42 FP/CT, the FP/TP value was 1.95, the precision was 33.89%, and the recall and F1 score were 89.70% and 49.20%, respectively. In contrast, the total number of nodules detected by AI Model 2 decreased significantly to 1 285, with 500 TP, 785 FP, and 63 FN. The detection sensitivity was 88.81%, the false positive rate was 6.71 FP/CT, the FP/TP value was 1.57, the precision was 40.00%, and the Recall and F1 score were 88.81% and 55.16%, respectively. When using AI Model 3 for lung nodule detection, 1 240 nodules were detected, including 493 TP and 747 FP, with 70 FN. The detection sensitivity was 87.57%, the false positive rate was 6.38 FP/CT, the FP/TP value was 1.52, the precision was 39.75%, and the recall and F1 score were 87.57% and 55.68%, respectively. It can be seen that all three AI models had high sensitivity in lung nodule detection, but Model 2 and Model 3 performed better in reducing false positive rate and improving precision. Model 2 was slightly superior to Model 3 in reducing false negatives (missed diagnosis) while maintaining a low false positive rate. Conclusion By comparing and analyzing multiple model detection indicators, it was found that Model 2 had the best overall performance and was the best choice for clinical lung nodule screening.