BACKGROUND:Based on different algorithms of machine learning,how to carry out clinical research on lumbar disc herniation with the help of various algorithmic models has become a trend and hot spot in the development of intelligent medicine at present. OBJECTIVE:To review the characteristics of different algorithmic models of machine learning in the diagnosis and treatment of lumbar disc herniation,and summarize the respective advantages and application strategies of algorithmic models for the same purpose. METHODS:The computer searched PubMed,Web of Science,EMBASE,CNKI,WanFang,VIP and China Biomedical(CBM)databases to extract the relevant articles on machine learning in the diagnosis and treatment of lumbar disc herniation.Finally,96 articles were included for analysis. RESULTS AND CONCLUSION:(1)Different algorithm models of machine learning provide intelligent and accurate application strategies for clinical diagnosis and treatment of lumbar disc herniation.(2)Traditional statistical methods and decision trees in supervised learning are simple and efficient in exploring risk factors and establishing diagnostic and prognostic models.Support vector machine is suitable for small data sets with high-dimensional features.As a nonlinear classifier,it can be applied to the recognition,segmentation and classification of normal or degenerative intervertebral discs,and to establish diagnostic and prognostic models.Ensemble learning can make up for the shortcomings of a single model.It has the ability to deal with high-dimensional data and improve the precision and accuracy of clinical prediction models.Artificial neural network improves the learning ability of the model,and can be applied to intervertebral disc recognition,classification and making clinical prediction models.On the basis of the above uses,deep learning can also optimize images and assist surgical operations.It is the most widely used model with the best performance in the diagnosis and treatment of lumbar disc herniation.The clustering algorithm in unsupervised learning is mainly used for disc segmentation and classification of different herniated segments.However,the clinical application of semi-supervised learning is relatively less.(3)At present,machine learning has certain clinical advantages in the identification and segmentation of lumbar intervertebral discs,classification and grading of the degenerative intervertebral discs,automatic clinical diagnosis and classification,construction of the clinical predictive model and auxiliary operation.(4)In recent years,the research strategy of machine learning has changed to the neural network and deep learning,and the deep learning algorithm with stronger learning ability will be the key to realizing intelligent medical treatment in the future.

Objective:To investigate the association between triglyceride-glucose (TyG) index and all-cause mortality in elderly patients with hypertension and coronary artery disease.Methods:This was a retrospective cohort study, a total of 5 640 elderly inpatients (≥65 years) with hypertension and coronary artery disease who were admitted to the Department of Cardiology, Liberation Army General Hospital from August 2008 to July 2018 were enrolled in this study. The baseline clinical data of the patients were collected and the TyG index was calculated. Patients were divided into four groups according to their TyG index quartiles: TyG index<8.31 ( Q1 group, n=1 392), 8.31≤TyG index<8.67 ( Q2 group, n=1 417), 8.67≤TyG index<9.07 ( Q3 group, n=1 427), and TyG index≥9.07 ( Q4 group, n=1 404). All patients were followed up by obtaining outpatient/rehospitalization records or by telephone. The primary endpoint was all-cause mortality. Log-rank test was used to compare the cumulative all-cause mortality among groups. Cox proportional hazard regression model was used to analyze the risk of all-cause mortality in each group (the Q2 group with the lowest all-cause mortality was used as a reference), after adjusting for confounding factors, Restricted cubic spline analysis (RCS) was used to determine the association between TyG index and risk of all-cause mortality. Results:During a follow-up of 6.44 (4.70, 8.85) years, 1 037 all-cause deaths (18.39 %) were documented. The cumulative all-cause mortality in Q1- Q4 groups was 16.52%, 16.51%, 17.59% and 22.93%, respectively, and the difference was statistically significant ( χ2=26.49, P<0.01). In the Cox regression model, compared with Q2 group (reference), the HR (95% CI) for all-cause mortality was 1.06 (0.88-1.28) in the Q1 group, 1.23 (1.02-1.48) in the Q3 group and 1.48 (1.23-1.77) in the Q4 group, respectively ( P for trend<0.01). RCS curve analysis showed that when the TyG index was greater than 8.67, the risk of all-cause mortality increased with the TyG index, and there was a linear relationship between TyG index and all-cause mortality in this patient cohort (non-linearity P=0.31). Conclusion:The elevated TyG index is significantly associated with a higher risk for all-cause mortality in elderly hypertension and coronary artery disease patients.

Biofilms are closely associated with the tough healing and dysfunctional inflammation of chronic wounds. Photothermal therapy (PTT) emerged as a suitable alternative which could destroy the structure of biofilms with local physical heat. However, the efficacy of PTT is limited because the excessive hyperthermia could damage surrounding tissues. Besides, the difficult reserve and delivery of photothermal agents makes PTT hard to eradicate biofilms as expectation. Herein, we present a GelMA-EGF/Gelatin-MPDA-LZM bilayer hydrogel dressing to perform lysozyme-enhanced PTT for biofilms eradication and a further acceleration to the repair of chronic wounds. Gelatin was used as inner layer hydrogel to reserve lysozyme (LZM) loaded mesoporous polydopamine (MPDA) (MPDA-LZM) nanoparticles, which could rapidly liquefy while temperature rising so as to achieve a bulk release of nanoparticles. MPDA-LZM nanoparticles serve as photothermal agents with antibacterial capability, could deeply penetrate and destroy biofilms. In addition, the outer layer hydrogel consisted of gelatin methacryloyl (GelMA) and epidermal growth factor (EGF) promoted wound healing and tissue regeneration. It displayed remarkable efficacy on alleviating infection and accelerating wound healing in vivo. Overall, the innovative therapeutic strategy we came up with has significant effect on biofilms eradication and shows promising application in promoting the repair of clinical chronic wounds.

Background::The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF.Methods::This cross-sectional study was conducted in Chinese People’s Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD.Results::The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28 % (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2DS 2-VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. Conclusions::AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

OBJECTIVES: The patients with mild traumatic brain injury (mTBI) accounts for more than 80% of the patients with brain injury. Most patients with mTBI have no abnormalities in CT examination. Therefore, most patients choose to self-care and recover rather than seeking medical treatment. In fact, mTBI may result in persistent cognitive decline and neurobehavioral dysfunction. In addition, changes occurred in neurochemistry, metabolism, and cells after injury may cause changes in cerebral blood flow (CBF), which is one of the causes of secondary injury and slow brain repair. This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling (ASL) magnetic resonance imaging technology. METHODS: In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University, 43 mTBI patients were collected as an mTBI group, and 43 normal subjects with age, gender, and education level matching served as a control group. They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging. In the mTBI group, 22 subjects were followed up at acute phase, 1 month, 3 months, and 12 months. Based on the control group, the abnormal regions of CBF in the whole brain of mTBI patients were analyzed. The abnormal regions were taken as the regions of interest (ROI). The correlation of the values of the CBF in ROIs with clinical indications, cognitive function, and the changes of CBF in ROI at each time point during the follow-up were analyzed. RESULTS: Compared with the control group, the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region, as well as the right putamen, caudate nucleus, globus pallidus, and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased (all P<0.01, TFCE-FWE correction). The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group, whole brain (r=0.528, P<0.001), right caudate nucleus (r=0.512, P<0.001), putamen (r=0.486, P<0.001), and globus pallidus (r=0.426, P=0.006) values of the were positively correlated with Backward Digit Span Test (BDST) score (reflectting working memory ability), and the right globus pallidus CBF was negatively correlated with the Post-Traumatic Stress Disorder Cheeklist-CivilianVersion (PCL-C) score (r=-0.402, P=0.010). Moreover, the follow-up study showed that abnormal CBF in these areas had not been restored. The correlation of CBF was negatively correlated with PCL-C and BDST at 1 months, 3 months, and 12 months (all P>0.05). CONCLUSIONS The elevated CBF value is one of the stress characteristics of brain injury in the mTBI patients at the acute phase. There is abnormal elevation of CBF values in multiple cortex or subcortical areas. Multi-time point studies show that there is no obvious change of CBF in abnormal areas, suggesting that potential clinical treatment is urgently needed for the mTBI patients.
Brain Concussion/diagnostic imaging* ; Brain Injuries ; Cerebrovascular Circulation/physiology* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging/methods* ; Magnetic Resonance Spectroscopy ; Spin Labels

Purpose: This study aimed to establish whether computed tomography (CT)–determined sarcopenia is a useful imaging biomarker for postoperative outcome in elderly colorectal cancer (CRC) patients, and construct sarcopenia-based nomograms to predict individual outcomes after surgery. Materials and Methods: CT imaging data of 298 elderly CRC patients who underwent surgery in 2012-2014 were retrospectively analyzed. Skeletal muscle mass was determined by CT, and sarcopenia was diagnosed based on the optimal cutoff value determined by X-tile program. The correlation between sarcopenia and risk of preoperative nutrition and postoperative complications was evaluated. A Cox proportional hazards model was used to determine survival predictors. Sarcopenia-based nomograms were developed based on multivariate analysis, and calibrated using concordance index and calibration curves. Results: A total 132 patients (44.3%) had sarcopenia based on the optimum cutoff values (29.9 cm2/m2 for women and 49.5 cm2/m2 for men). Sarcopenia was an independent risk factor for preoperative nutrition (p < 0.001; odds ratio [OR], 3.405; 95% confidence interval [CI], 1.948 to 5.954) and postoperative complications (p=0.008; OR, 2.192; 95% CI, 1.231 to 3.903). Sarcopenia was an independent predictor for poor progression-free survival (p < 0.001; hazard ratio [HR], 2.175; 95% CI, 1.489 to 3.179) and overall survival (p < 0.001; HR, 2.524; 95% CI, 1.721 to 3.703). Based on multivariate analysis, we produced four nomograms that had better predictive performance. Conclusion CT-determined sarcopenia is a useful imaging biomarker for predicting preoperative nutritional risk, postoperative complications, and long-term outcomes in elderly CRC patients. The sarcopenia-based nomograms can provide a scientific basis for guiding therapeutic schedule and follow-up strategies.

Objective To study the clinical effect of diversion treatment for complex anal fistula.Methods A total of 60 patients with complex anal fistula were enrolled in this study were divided into control group and experimental group according to the random number table method,with 30 cases per group.All patients were given routinely imaging examination and other related checks,and the intestine tract was cleaned in the morning of the operative day.The control group were treated with low anal fistula resection,while the experimental group with diversion treatment.The efficacy of treatment,postoperative anal function,wound healing time and pain were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group (P ＜ 0.05).The Wexner score of the anus function in the experimental group was lower than that in the control group at 1,7,14 and 21 d after the operation,and the differences were statistically significant (P ＜ 0.05).The wound healing time,VAS score on 14thpostoperative day,intraoperative wound area and postoperative scar size were lower in the experimental group than that in the control group (P ＜ 0.05).Conclusion Diversion treatment for complex anal fistula has significant efficacy,faster postoperative wound healing,and it can effectively relieve clinical symptoms and signs,improve anal function,reduce body pain,so it is worthy of clinical promotion.

Objective To study the clinical effect of diversion treatment for complex anal fistula.Methods A total of 60 patients with complex anal fistula were enrolled in this study were divided into control group and experimental group according to the random number table method,with 30 cases per group.All patients were given routinely imaging examination and other related checks,and the intestine tract was cleaned in the morning of the operative day.The control group were treated with low anal fistula resection,while the experimental group with diversion treatment.The efficacy of treatment,postoperative anal function,wound healing time and pain were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group (P ＜ 0.05).The Wexner score of the anus function in the experimental group was lower than that in the control group at 1,7,14 and 21 d after the operation,and the differences were statistically significant (P ＜ 0.05).The wound healing time,VAS score on 14thpostoperative day,intraoperative wound area and postoperative scar size were lower in the experimental group than that in the control group (P ＜ 0.05).Conclusion Diversion treatment for complex anal fistula has significant efficacy,faster postoperative wound healing,and it can effectively relieve clinical symptoms and signs,improve anal function,reduce body pain,so it is worthy of clinical promotion.

OBJECTIVE: To investigate the effect of rapamycin on Parkinson's disease (PD) and its underlying mechanism in mice. METHODS: Sixty SPF adult male C57BL/6 mice were randomly divided into control group, model group and treatment group. 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine(MPTP) was used to induce Parkinson's disease in model group and treatment group. All mice were trained to cross the runway and were subjected to computer-assisted CatWalk. The numbers of tyrosine hydroxylase positive (TH) neurons in the substantia nigra (SN) were assessed by unbiased stereology using the optical fractionator method; protein expression was detected by Western blot analysis; and glutathione peroxidase (GSH-Px), malondialdehyde (MDA) and superoxide dismutase (SOD) were detected by spectrophotometry. RESULTS: In the model group, a decrease in stride rate and an increase in variation of stance and swing were noted by CatWalk system (<0.05 or <0.01); the numbers of TH neurons decreased (<0.01); expression of p-Akt, p-S6K, p-S6 and p-ULK increased (all <0.01); LC3-Ⅱ/Ⅰ ratio decreased (<0.01); MDA level was elevated while the levels of SOD and GSH-PX were reduced (all <0.01). Compared with the model group, after treated with rapamycin, the abnormal behavior including the stride length, variation of stance and swing and step patterns induced by MPTP were all improved (<0.05 or <0.01); the numbers of TH neurons increased (<0.05); the expression of p-Akt, p-S6K, p-S6 and p-ULK was suppressed (all <0.01); the LC3-Ⅱ/Ⅰ ratio was upregulated (<0.05); MDA level decreased while the levels of GSH-Px and SOD increased (all <0.01). CONCLUSIONS Rapamycin inhibits the activation of mTOR pathway, which contributes to protect against the loss of dopaminergic neurons and provide behavioral improvements in mice with Parkinson's disease. These results are partially related to the ability of rapamycin in inducing autophagy and reducing oxidative stress.
Animals ; Behavior, Animal ; drug effects ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL ; Neuroprotective Agents ; pharmacology ; therapeutic use ; Oxidative Stress ; drug effects ; Parkinson Disease ; drug therapy ; Random Allocation ; Sirolimus ; pharmacology ; therapeutic use ; Substantia Nigra ; drug effects

Objective To assess the empathy level of general practitioners (GPs) in the outpatient clinics of a general hospital,and to investigate the related factors.Methods Patients attending the Family Medicine Clinic of HKU-Shenzhen Hospital in September 2014 and met the inclusion criteria were asked to complete the questionnaire which included general characteristics,overall satisfaction and the Measure-Consultation and Relational Empathy Measure (CARE) Scale after the consultation.Results Of the 1 818 questionnaires retrieved,1 690 CARE scales were completed (intact rate was 92.96%).The overall satisfaction rate was 95.92% (1 621/1 690).And 97.28% (1 644/1 690) of the patients would recommend family medicine service to their friends or relatives.The total score of CARE scale was (45.47±6.26),and the scores of 4 CARE components were (4.63 ± 0.59),(4.43 ± 0.81),(4.54 ± 0.69) and (4.55 ± 0.66),which showed significant difference (P<0.01).The multivariate linear regression analysis showed that the mean CARE scores were not influenced by gender and education levels of the patients,gender of the consulting doctors,initial/follow up consultation,and the location of the consultation.The mean CARE scores were influenced by age of patients and the reasons for consulting (P<0.05).There was a moderate correlation of the CARE scores with the overall satisfaction of patients (r=0.613,P<0.001) and patient's recommendation of the clinic (r=0.466,P<0.001).Conclusion Doctors who were evaluated in this study have a higher empathy level than results from other countries.There is positive correlation between doctor's empathy level and patient's overall satisfaction.The result of doctor's empathy level may be influenced by patient's age and the reasons for consulting.