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Abstract Objectives Radiomics has been demonstrated to be strongly associated with TNM stage and patient prognosis. We aimed to develop a model for predicting lymph node metastasis (LNM) and survival. Methods For radiomics texture selection, 3D Slicer 5.0.3 software and the least absolute shrinkage and selection operator (LASSO) algorithm were used. Subsequently, the radiomics model, computed tomography (CT) image, and clinical risk model were compared. The performance of the three models was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration plots, and clinical impact curves (CICs). Results For the LNM prediction model, 224 patients with LNM information were used to construct a model that was applied to predict LNM. According to the CT data and clinical characteristics, we constructed a radiomics model, CT imaging model and clinical model. The radiomics model for evaluating LNM status showed excellent calibration and discrimination in the training cohort (AUC = 0.926, 95% CI = 0.869–0.982) and the validation cohort (AUC = 0.872, 95% CI = 0.802–0.941). DeLong’s test demonstrated that the difference among the three models was significant. Similarly, DCA and CIC showed that the radiomics model has better clinical utility than the CT imaging model and clinical model. Our model also exhibited good performance in predicting survival—in line with the findings of the model built with clinical risk factors. Conclusions CT radiomics models exhibited better predictive performance for LNM than models built based on clinical risk characteristics and CT imaging and had comparative clinical utility for predicting patient prognosis. Critical relevance statement The radiomics model showed excellent performance and discrimination for predicting LNM and survival of duodenal papillary carcinoma (DPC). Key Points LNM status determines the most appropriate treatment for DPC. Our radiomics model for evaluating the LNM status of DPC performed excellently. The radiomics model had high sensitivity and specificity for predicting survival, exhibiting great clinical value. Graphical Abstract

In this paper, on the premise that the prior probability is unknown, a noise enhanced binary hypothesis-testing is investigated under the Minimax criterion for a general nonlinear system. Firstly, for lowering the decision risk, an additive noise is intentionally injected to the input and a decision is made under Minimax criterion based on the noise modified output. Then an optimization problem for minimizing the maximum of Bayesian conditional risk under an equality constraint is formulated via analyzing the relationship between the additive noise and the optimal noise modified Minimax decision rule. Furthermore, lemma and theorem are proposed to prove that the optimal noise is a constant vector, which simplifies the optimization problem greatly. An algorithm is also developed to search the optimal constant and the key parameter of detector, and further to determine the decision rule and the Bayes risk. Finally, simulation results about the original (in the absence of additive noise) and the noise-modified optimal decision solutions under Minimax criterion for a sine transform system are provided to illustrate the theoretical results.

ABSTRACT Lactococcus garvieae is a fish pathogen that can cause diseases in humans and cows. Two genetically related species, Lactococcus formosensis and Lactococcus petauri, may be misidentified as L. garvieae. It is unclear if these species differ in host specificity and virulence genes. This study analyzed the genomes of 120 L. petauri, 53 L. formosensis, and 39 L. garvieae isolates from various sources. The genetic diversity and virulence gene content of these isolates were compared. The results showed that 77 isolates previously reported as L. garvieae were actually L. formosensis or L. petauri. The distribution of the three species varied across different collection sources, with L. petauri being predominant in human infections, human fecal sources, and rainbow trout, while L. formosensis was more common in bovine isolates. The genetic diversity of isolates within each species was high and similar. Using a genomic clustering method, L. petauri, L. formosensis, and L. garvieae were divided into 45, 22, and 13 clusters, respectively. Most rainbow trout and human isolates of L. petauri belonged to different clusters, while L. formosensis isolates from bovine and human sources were also segregated into separate clusters. In L. garvieae, most human isolates were grouped into three clusters that also included isolates from food or other sources. Non-metric multidimensional scaling ordination revealed the differential association of 15 virulence genes, including 14 adherence genes and a bile salt hydrolase gene, with bacterial species and certain collection sources. In conclusion, this work provides evidence of host specificity among the three species.IMPORTANCELactococcus formosensis and Lactococcus petauri are two newly discovered bacteria, which are closely related to Lactococcus garvieae, a pathogen that affects farmed rainbow trout, as well as causes cow mastitis and human infections. It is unclear whether the three bacteria differ in their host preference and the presence of genes that contribute to the development of disease. This study shows that L. formosensis and L. petauri were commonly misidentified as L. garvieae. The three bacteria showed different distribution patterns across various sources. L. petauri was predominantly found in human infections and rainbow trout, while L. formosensis was more commonly detected in cow mastitis. Fifteen genes displayed a differential distribution among the three bacteria from certain sources, indicating a genetic basis for the observed host preference. This work indicates the importance of differentiating the three bacteria in diagnostic laboratories for surveillance and outbreak investigation purposes.

Abstract Limited endoscopic sphincterotomy (EST) combined with endoscopic papillary balloon dilation (EPBD) is widely used. However, the optimal duration of small balloon dilation in choledocholithiasis remains controversial. We aimed to determine the optimal duration for 10 mm diameter balloon dilation after limited EST in choledocholithiasis. In this randomized controlled clinical trial, 320 patients were randomly assigned to receive small balloon dilation (10 mm in diameter) for 1 min (n = 160) or 3 min (n = 160) after deep bile duct cannulation. No significant difference in success rate of stone extraction between the two groups was observed. The incidence of post-ERCP pancreatitis (PEP) was higher in the 1 min group (10.6%) than in the 3 min group (4.4%) (P = 0.034). The logistic regression analysis showed that guidewire into the pancreatic duct, cannulation time > 5 min and 1 min balloon dilation were independent risk factors for PEP. There were no significant differences in other post-ERCP adverse events such as acute cholangitis, bleeding, perforation, etc. between the two groups. In conclusion, 3 min in duration was determined to be the optimal dilation condition for the removal of common bile duct stones.

There are many studies on the application of raw diatomite. Still, there are few studies on using waste diatomite to partially replace cement in concrete, especially in the literature regarding mechanical properties and heat insulation. As such, many waste diatomaceous earths are buried yearly. This study used recycled diatomite to replace part of the cement (10%, 15%, 20%, 30%, 40%) to make mixed cement mortar. Various tests were performed to determine its properties and thermal insulation benefits. According to the results of multiple tests, the amount of replacement diatomite increases the amount of mixing water and setting time. The weight loss and shrinkage rates of the freeze-thaw cycles also increased. However, its water absorption and thermal conductivity decreased. Regarding compressive strength, 10% diatomite substitution had higher strength at 28 days, but 20% diatomite substitution had higher strength at 90 days. The volume change did not exceed the 0.1% critical value specified in ASTM standards. These findings indicate that the most potential results (in terms of mechanical and thermal insulation performance) can be obtained in blends with 20% waste diatomite from the brewing industry.

Seeking novel high-performance elastocaloric materials with low critical stress plays a crucial role in advancing the development of elastocaloric refrigeration technology. Here, as a first attempt, the elastocaloric effect of TiZrNbAl shape memory alloy at both room temperature and finite temperatures ranging from 245 K to 405 K, is studied systematically. Composition optimization shows that Ti-19Zr-14Nb-1Al (at.%), possessing excellent room-temperature superelasticity with a critical stress of around 100 MPa and a small stress hysteresis of around 70 MPa and outstanding fracture resistance with a compressive strain of 20% and stress of 1.7 GPa, demonstrates a substantial advantage as an elastocaloric refrigerant. At room temperature, a large adiabatic temperature change (ΔTad) of −6.7 K is detected, which is comparable to the highest value reported in the Ti-based alloys. A high elastocaloric cyclic stability, with almost no degradation of ΔTad after 4000 cycles, is observed. Furthermore, the sizeable elastocaloric effect can be steadily expanded from 255 K to 395 K with a temperature window of as large as 140 K. A maximum ΔTad of −7.9 K appears at 355 K. The present work demonstrates a promising potential of TiZrNbAl as a low critical stress and low hysteresis elastocaloric refrigerant.

Abstract Objective This study aims to screen for measures and lipid-derived indicators associated with insulin resistance (IR) in obese children and adolescents and develop a nomogram model for predicting the risk of insulin resistance. Methods A total of 404 eligible obese children and adolescents aged 10–17 years were recruited for this study from a summer camp between 2019 and 2021. The risk factors were screened using the least absolute shrinkage and selection operator (LASSO)-logistic regression model, and a nomogram model was developed. The diagnostic value of the model was evaluated by plotting the receiver operator characteristic curve and calculating the area under the curve. Internal validation was performed using the Bootstrap method, with 1000 self-samples to evaluate the model stability. The clinical applicability of the model was assessed by plotting the clinical decision curve. Results On the basis of the LASSO regression analysis results, three lipid-related derivatives, TG/HDL-c, TC/HDL-c, and LDL-c/HDL-c, were finally included in the IR risk prediction model. The nomogram model AUC was 0.804 (95% CI: 0.760 to 0.849). Internal validation results show a C-Index of 0.799, and the mean absolute error between the predicted and actual risks of IR was 0.015. The results of the Hosmer–Lemeshow goodness-of-fit test show a good model prediction (χ2 = 9.523, P = 0.300). Conclusion Three early warning factors, TG/HDL-c, TC/HDL-c, and LDL-c/HDL-c, were screened, which can effectively predict the risk of developing IR in obese children and adolescents, and the nomogram model has an eligible diagnostic value.

This study extends previous research by examining the mental health issues of international mainland Chinese college students in Thailand. The research specifically proposed that mental health issues originate from the relationship between life adaptation and mental health disorders, and this study was conducted to test this assertion. Nine hundred international mainland Chinese college students in Thailand participated in an online survey. The results showed that life adaptation in respect of family relationships, interpersonal relationships, emotions, and learning had a positive effect on mental health disorders and that female and junior students who stayed in Thailand for 1 to 2 years were likely to have significant mental health issues.

Thai Immigration Department shows the total number of Chinese nationals residing in Thailand at 91,272 in 2015, however, academic studies reveal the figure to be as high as 350,000-400,000 in the past decade. In terms of the huge population, except economic benefit to Thailand and more cross-cultural settings in the campus, there is a critical issue requiring urgent attention. Colleges cannot guarantee high-quality learning and consequently cannot attain their mission, accomplish their goals, or serve their valuable social, economic and public objectives without engaging in the mental and behavioral health matters of their students. Accordingly, this study aimed to examine Chinese international students' mental health and cross-cultural adaptation to study abroad in a university at Bangkok and investigate whether or not two factors were related to one another. A survey was applied for this investigation. The participants were 900 Chinese international students at a Thai university. The research discovered that different levels of college degrees and length of residence in Thailand were two main factors to influence mental health and cross-cultural adaptation. Incoming students and graduates specifically has a potential problem in cross-cultural adaptation.

ObjectiveTo compare the diagnostic value of cytobrush, ERCP-guided biopsy, SpyGlass direct visual impression and SpyGlass-guided biospy (SpyBite) in the differential diagnosis of benign and malignant bile duct strictures.MethodsThe data of 1,008 patients who were clinically diagnosed with indeterminate biliary strictures and underwent ERCP-guided biopsy, cytobrush, SpyGlass direct visual impression or SpyBite at the First Affiliated Hospital of Nanchang University between January 2010 and December 2019 were collected and analyzed retrospectively. The final diagnose was determined by surgical pathological specimen or follow-up (Malignant stricture can be identified if the stricture showed malignant progression during one year of follow-up). The differential diagnostic value of the above endoscopic diagnostic methods was evaluated by means of sensitivity, specificity, accuracy, positive predictive value, negative predictive value, etc. and safety was evaluated by the incidence rate of adverse events.ResultsIn terms of sensitivity, standard biopsy group (48.6%) and SpyBite group (61.5%) were significantly higher than cytobrush group (32.0%), and visual impression group (100%) was significantly higher than any other group. As far as specificity was concerned, cytobrush group (99.0%), standard biopsy group (99.3%) and the SpyBite group (100%) were significantly higher than visual impression (55.6%), but there was no statistical difference among the three groups above. As far as accuracy was concerned, standard biopsy group (65.3%), and SpyBite group (80.0%) were significantly higher than cytobrush group (44.4%), and SpyBite group (80.0%) was significantly higher than visual impression group (54.8%). In terms of safety, visual impression group and SpyBite group were significantly higher than cytobrush group and standard biopsy group in post-ERCP cholangitis.ConclusionSpyBite combined with SpyGlass-guided visual impression was better for differential diagnosis of benign and malignant bile duct strictures in terms of sensitivity and accuracy compared with conventional endoscopic diagnostic methods such as cytobrush and standard biopsy. Furthmore, the incidence rates of adverse events after SpyGlass examination was similar to those after conventional endoscopic diagnostic methods except for higher cholangitis, which could be controlled by antibiotics and might be avoided by adequate biliary drainage.

Hereditary hemorrhagic telangiectasis (HHT) and juvenile polyposis syndrome (JPS) are both relatively rare hereditary disorders. It has been reported that patients with SMAD4 mutations may suffer from both HHT and JPS, defined as JPS/HHT. To improve the understanding and diagnosis of these diseases, we herein report a case of a 17-year-old male with abdominal pain and hematochezia. Low-tension computed tomography (CT) of the small intestine showed intussusception. Combined with the patient’s medical history of nasal bleeding and pulmonary arteriovenous fistula (pAVF) embolism, a final diagnosis of JPS/HHT was reached, according to the Curaçao Diagnostic Criteria. The possibility of JPS/HHT should be considered in patients with epistaxis and intussusception.

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) has become an important method to diagnose and treat biliary-pancreatic diseases. Perforations are infrequent but serious complications can occur during ERCPs. However, it is unclear which patients are suitable for surgery and when these patients should receive surgery.AimTo analyze the outcome of 45 patients with endoscopic retrograde cholangiopancreatography (ERCP) related perforation.Materials and methodsWe retrospectively reviewed all 45 patients with ERCP-related perforation between January 2003 and December 2017, and observed the location and causes of perforation, treatment strategies, and mortality.ResultsTwenty thousand four hundred and seventy-nine patients received ERCP procedures from January 2003 to December 2017 in our digestive endoscopy center. Forty-five patients suffered from ERCP-related perforations. The incidence rate of ERCP-related perforations was 0.22%. Twenty-six patients suffered from periampullary perforations, 15 patients suffered from duodenal wall perforations, 1 patient suffered from a fundus perforation, 1 patient suffered from a residual gallbladder duct perforation, 1 patient suffered from a papillary diverticulum perforation, and 1 patient suffered from an intrahepatic bile duct perforation. Six patients with duodenal perforations underwent surgery, and the other patients received conservative treatment. One patient with a duodenal perforation and ERCP-related pancreatitis died of heart failure, and all the other patients recovered. The mortality rate was 2.2%.ConclusionEndoscopic closure is seen as the first method for treating Stapfer type I perforations in the early phase, and surgery is seen as a remedial method when local treatment was failed. The Stapfer type II to type IV perforations can recover by conservative treatment.

BackgroundIntermittent energy restriction (IER) and continuous energy restriction (CER) are increasingly popular dietary approaches used for weight loss and overall health. These energy restriction protocols combined with exercise on weight loss and other health outcomes could achieve additional effects in a short-term intervention.ObjectivesTo evaluate the effects of a 4-week IER or CER program on weight, blood lipids, and CRF in overweight/obese adults when combined with high-intensity interval training (HIIT).MethodsForty-eight overweight/obese adults [age: 21.3 ± 2.24 years, body mass index (BMI): 25.86 ± 2.64 kg⋅m–2] were randomly assigned to iER, cER, and normal diet (ND) groups (n = 16 per group), each consisting of a 4-week intervention. All of the groups completed HIIT intervention (3 min at 80% of V̇O2max followed by 3 min at 50% of V̇O2max), 30 min/training sessions, five sessions per week. iER subjects consumed 30% of energy needs on 2 non-consecutive days/week, and 100% of energy needs on another 5 days; cER subjects consumed 70% of energy needs; and ND subjects consumed 100% of energy needs. Body composition, waist circumference (WC) and hip circumference (HC), triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c), and cardiorespiratory fitness (CRF) were measured before and after the intervention.ResultsOf the total 57 participants who underwent randomization, 48 (84.2%) completed the 4-week intervention. After intervention body composition and body circumference decreased in three groups, but no significant differences between groups. The iER tends to be superior to cER in the reduction of body composition and body circumference. The mean body weight loss was 4.57 kg (95% confidence interval [CI], 4.1–5.0, p < 0.001) in iER and 2.46 kg (95% CI, 4.1–5.0, p < 0.001) in iER. The analyses of BMI, BF%, WC, and HC were consistent with the primary outcome results. In addition, TG, TC, HDL-c, and CRF improved after intervention but without significant changes (p > 0.05).ConclusionBoth IER and CER could be effective in weight loss and increased CRF when combined with HIIT. However, iER showed greater benefits for body weight, BF%, WC, and HC compared with cER.