Objective The effect of intra-aortic balloon counterpulsation combined with recombinant human brain natriuretic peptide(rhBNP)treatment on ventricular remodeling after percutaneous coronary intervention(PCI)in elderly patients with acute anterior wall myocardial infarction.Methods A retrospective analysis was con-ducted on 66 elderly patients with acute anterior myocardial infarction who underwent emergency PCI in our hospital from January 2018 to June 2023.They were divided into a control group(n=32)who underwent PCI+rhBNP,and a study group(n=32)who underwent PCI+rhBNP+intra-aortic balloon counterpulsation.Blood pressure,lactic acid level,mechanical complications,ventricular remodeling,inflammatory factors,myocardial enzymology,ox-LDL level were detected and compared between the two groups.Results Before treatment,Lactic acid,diastolic blood pressure,systolic blood pressure,left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPWT),left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),homocysteine(Hcy),interleukin-6(IL-6)and myocardial troponin were compared between the two groups.Myocardial troponin T(cTnT),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB),oxidized low density lipoprotein(ox-LDL)levels(P>0.05);At 3 months follow-up after discharge,the levels of lactic acid,LVESD,LVEDD,LVPWT,LVRI,Hcy,IL-6,cTnT,LDH,CK-MB and ox-LDL were decreased,and the levels were lower in the study group,and the levels of diastolic blood pressure,systolic blood pressure and LVEF were increased,and the levels were higher in the study group(P<0.05).The pro-portion of mechanical complications between the two groups before and after treatment were compared(P>0.05).Conclusion In elderly patients with acute anterior myocardial infarction after emergency PCI,intra-aortic balloon counterpulsation combined with rhBNP could alleviate ventricular remodeling,myocardial injury,reduce inflamma-tory injury,improve oxidative stress response,and regulate tissue perfusion.

Objective The effect of intra-aortic balloon counterpulsation combined with recombinant human brain natriuretic peptide(rhBNP)treatment on ventricular remodeling after percutaneous coronary intervention(PCI)in elderly patients with acute anterior wall myocardial infarction.Methods A retrospective analysis was con-ducted on 66 elderly patients with acute anterior myocardial infarction who underwent emergency PCI in our hospital from January 2018 to June 2023.They were divided into a control group(n=32)who underwent PCI+rhBNP,and a study group(n=32)who underwent PCI+rhBNP+intra-aortic balloon counterpulsation.Blood pressure,lactic acid level,mechanical complications,ventricular remodeling,inflammatory factors,myocardial enzymology,ox-LDL level were detected and compared between the two groups.Results Before treatment,Lactic acid,diastolic blood pressure,systolic blood pressure,left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPWT),left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),homocysteine(Hcy),interleukin-6(IL-6)and myocardial troponin were compared between the two groups.Myocardial troponin T(cTnT),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB),oxidized low density lipoprotein(ox-LDL)levels(P>0.05);At 3 months follow-up after discharge,the levels of lactic acid,LVESD,LVEDD,LVPWT,LVRI,Hcy,IL-6,cTnT,LDH,CK-MB and ox-LDL were decreased,and the levels were lower in the study group,and the levels of diastolic blood pressure,systolic blood pressure and LVEF were increased,and the levels were higher in the study group(P<0.05).The pro-portion of mechanical complications between the two groups before and after treatment were compared(P>0.05).Conclusion In elderly patients with acute anterior myocardial infarction after emergency PCI,intra-aortic balloon counterpulsation combined with rhBNP could alleviate ventricular remodeling,myocardial injury,reduce inflamma-tory injury,improve oxidative stress response,and regulate tissue perfusion.

Objective To evaluate the predictive value of serum carbohydrate antigen 50(CA50),tumor specific growth factor(TSGF),and tissue polypeptide antigen(TPA)levels for sensitivity to radiochemotherapy in patients with middle-and advanced-stage breast cancer using a nomogram model.Methods Eighty-two patients with middle-and advanced-stage breast cancer were selected as the study sub-jects.All patients received paclitaxel chemotherapy combined with radiotherapy and were divided into sensitive(n= 57)and insensitive(n= 25)groups according to the Response Evaluation Criteria in Solid Tumors.The general information of the patients,serum expression of CA50,TSGF,and TPA,and their differences before and after treatment were recorded.A nomogram model was constructed,and cali-bration curves,receiver operating characteristic(ROC)curves,and decision curves were used to evaluate the predictive power and clinical utility of the nomogram model.Results Significant differences were observed in tumor diameter,vascular invasion,TNM stage,lymph node metastasis,and degree of differentiation between the two groups(P＜0.05).Compared to those in the sensitive group,the serum expression of CA50,TSGF,and TPA after treatment was higher,and the difference in CA50,TSGF,and TPA was smaller in the insensitive group(P＜0.05).Three predictive variables were identified in the LASSO regression:differences in CA50,TSGF,and TPA.The logistic regression results showed that differences in CA50,TSGF,and TPA influenced sensitivity to radiochemotherapy in middle-and advanced-stage breast cancer(P＜0.05).A nomogram model was constructed using differences in CA50,TSGF,and TPA.Calibration,ROC,and decision curves showed the model's good predictive accuracy and clinical utility.Conclusion Serum expression of CA50,TSGF,and TPA is high in patients with middle-and advanced-stage breast cancer who are insensitive to radiochemotherapy,and differences in CA50,TSGF,and TPA affect their sensitivity to radiochemotherapy.The nomogram model had good predictive value and clinical utility.

Objective:To analyze the present situation and influencing factors of operational efficiency of tertiary public hospitals in Anhui province, so as to provide reference for promoting the development of medical and health care in Anhui province.Methods:The operational efficiency index of performance appraisal of national tertiary public hospitals was taken as the research index system. The operational efficiency data of 75 tertiary public hospitals in Anhui province in 2020 and 2021 were extracted from the " 2021 Performance Appraisal Analysis Report of Anhui Provincial Tertiary Public Hospitals" compiled by the Anhui Provincial Public Hospital Supervision and Management Center. The entropy weight TOPSIS method was used to evaluate the operational efficiency, and logistic regression analysis was used to identify the influencing factors of operational efficiency of tertiary public hospitals in Anhui province.Results:Among the 9 operational efficiency indicators, 7 indicators showed better data in 2021 than in 2020. The proportion of medical service revenue in medical revenue and the proportion of personnel expenses in operating expenses were the key indicators affecting the operational efficiency. Multivariate logistic regression analysis showed that specialized hospitals ( OR=3.350, 95% CI 1.068-11.591) and annual outpatient visits>500 000 ( OR=0.248, 95% CI 0.073-0.845) were the influencing factors on the operational efficiency of tertiary public hospitals in Anhui province ( P<0.05). Conclusions:The operational efficiency of tertiary public hospitals in Anhui province was improved overall in 2021 compared with 2020. It is suggested to further optimize the structure of hospital revenue and expenditure, promote the implementation of hierarchical diagnosis and treatment policy, and optimize the allocation of health resources, so as to guide hospitals to improve operational efficiency through connotative development.

Objective:To analyze the present situation and influencing factors of operational efficiency of tertiary public hospitals in Anhui province, so as to provide reference for promoting the development of medical and health care in Anhui province.Methods:The operational efficiency index of performance appraisal of national tertiary public hospitals was taken as the research index system. The operational efficiency data of 75 tertiary public hospitals in Anhui province in 2020 and 2021 were extracted from the " 2021 Performance Appraisal Analysis Report of Anhui Provincial Tertiary Public Hospitals" compiled by the Anhui Provincial Public Hospital Supervision and Management Center. The entropy weight TOPSIS method was used to evaluate the operational efficiency, and logistic regression analysis was used to identify the influencing factors of operational efficiency of tertiary public hospitals in Anhui province.Results:Among the 9 operational efficiency indicators, 7 indicators showed better data in 2021 than in 2020. The proportion of medical service revenue in medical revenue and the proportion of personnel expenses in operating expenses were the key indicators affecting the operational efficiency. Multivariate logistic regression analysis showed that specialized hospitals ( OR=3.350, 95% CI 1.068-11.591) and annual outpatient visits>500 000 ( OR=0.248, 95% CI 0.073-0.845) were the influencing factors on the operational efficiency of tertiary public hospitals in Anhui province ( P<0.05). Conclusions:The operational efficiency of tertiary public hospitals in Anhui province was improved overall in 2021 compared with 2020. It is suggested to further optimize the structure of hospital revenue and expenditure, promote the implementation of hierarchical diagnosis and treatment policy, and optimize the allocation of health resources, so as to guide hospitals to improve operational efficiency through connotative development.

OBJECTIVE: To review the current applications of machine learning in orthopaedic trauma and anticipate its future role in clinical practice. METHODS: A comprehensive literature review was conducted to assess the status of machine learning algorithms in orthopaedic trauma research, both nationally and internationally. RESULTS: The rapid advancement of computer data processing and the growing convergence of medicine and industry have led to the widespread utilization of artificial intelligence in healthcare. Currently, machine learning plays a significant role in orthopaedic trauma, demonstrating high performance and accuracy in various areas including fracture image recognition, diagnosis stratification, clinical decision-making, evaluation, perioperative considerations, and prognostic risk prediction. Nevertheless, challenges persist in the development and clinical implementation of machine learning. These include limited database samples, model interpretation difficulties, and universality and individualisation variations. CONCLUSION The expansion of clinical sample sizes and enhancements in algorithm performance hold significant promise for the extensive application of machine learning in supporting orthopaedic trauma diagnosis, guiding decision-making, devising individualized medical strategies, and optimizing the allocation of clinical resources.
Artificial Intelligence ; Orthopedics ; Machine Learning ; Algorithms

Genome-wide association studies (GWASs) are the most widely used method to identify genetic risk loci associated with orofacial clefts (OFC). However, despite the increasing size of cohort, GWASs are still insufficient to detect all the heritability, suggesting there are more associations under the current stringent statistical threshold. In this study, we obtained an integrated epigenomic dataset based on the chromatin conformation of a human oral epithelial cell line (HIOEC) using RNA-seq, ATAC-seq, H3K27ac ChIP-seq, and DLO Hi-C. Presumably, this epigenomic dataset could reveal the missing functional variants located in the oral epithelial cell active enhancers/promoters along with their risk target genes, despite relatively less-stringent statistical association with OFC. Taken a non-syndromic cleft palate only (NSCPO) GWAS data of the Chinese Han population as an example, 3664 SNPs that cannot reach the strict significance threshold were subjected to this functional identification pipeline. In total, 254 potential risk SNPs residing in active cis-regulatory elements interacting with 1 718 promoters of oral epithelium-expressed genes were screened. Gapped k-mer machine learning based on enhancers interacting with epithelium-expressed genes along with in vivo and in vitro reporter assays were employed as functional validation. Among all the potential SNPs, we chose and confirmed that the risk alleles of rs560789 and rs174570 reduced the epithelial-specific enhancer activity by preventing the binding of transcription factors related to epithelial development. In summary, we established chromatin conformation datasets of human oral epithelial cells and provided a framework for testing and understanding how regulatory variants impart risk for clefts.
Chromatin ; Cleft Lip/genetics* ; Cleft Palate/genetics* ; Epithelium ; Genome-Wide Association Study ; Humans

Objective:To prevent the occurrence of children′s unintentional injuries, clinical characteristics were analyzed for 1 379 children hospitalized for unintentional injuries over a 5-year period at the First Affiliated Hospital of Xiamen University.Methods:We searched the First Affiliated Hospital of Xiamen University Pediatric Refined Management Database for all cases of children aged 0-14 years who were hospitalized for unintentional injuries from January 1, 2015 to December 31, 2019.Descriptive statistics were calculated for age, gender, season of injury, location of residence, education level of the child′s parents/guardians, injury etiology and outcome, and cost of treatment.Results:Of 1 379 cases, 894 children(64.8%) were boys and 485(35.2%) were girls.The majority of cases were 1-5 years old(61.6%, n=849). The top three causes of unintentional injuries were foreign bodies(38.1%, n=526), falls(27.0%, n=372), and burns(17.1%, n=236). Children′s unintentional injuries occurred most frequently during the summer(29.0%). More children came from rural locations(56.3%, n=777). Approximately half of the parents/guardians had attained an education level of junior high school or below(50.5%, n=696). There were 47 cases(3.4%) resulting in death or permanent injury and 292 cases(21.2%) resulting in disability.Children injured in traffic accidents had the longest average length of hospital stay [11(7, 18)d] and incurred the highest healthcare costs per case[11 130.32(5 389.69, 24 216.90)RMB]. Conclusion:Children′s unintentional injuries are concentrated among rural boys aged 1-5 years, foreign bodies are the most common cause of unintentional injuries.Children from families with low parental/guardian education levels may be at heightened risk of unintentional injuries.

Small intestine

Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients′ urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons′ attention of nerve preservation technique and to improve their understanding of ELAPE procedure.