The linear analysis for heart rate variability (HRV), including time domain method, frequency domain method and time-frequency analysis, has reached a lot of consensus. The non-linear analysis has also been widely applied in biomedical and clinical researches. However, for non-linear HRV analysis, especially for short-term non-linear HRV analysis, controversy still exists, and a unified standard and conclusion has not been formed. This paper reviews and discusses three short-term non-linear HRV analysis methods (fractal dimension, entropy and complexity) and their principles, progresses and problems in clinical application in detail, in order to provide a reference for accurate application in clinical medicine.
Electrocardiography ; Entropy ; Fractals ; Heart Rate ; Humans

Objective To study the cause,prevention and treatment of postpancreaticoduodenectomy hemorrhage.Method The clinical data of 422 patients who underwent PD in our hospital between January 2000 and January 2012 were retrospective analyzed.Results The incidence of postoperative hemorrhage was 8.1％ (34/422),and the mortality was 20.6％ (7/34).Early and delayed hemorrhage occurred in 19 and 15 patients,respectively.Intra-abdominal and gastrointestinal hemorrhage occurred in 20 and 14 patients,respectively.For the 19 patients who underwent reoperation,the mortality was 20.6％ (7/34).When compared with the delayed hemorrhage group,the mortality of the early hemorrhage group was significantly lower (P＜0.05).Conclusions Meticulous operation and reliable hemostasis during operation and prevention of pancreatic fistula,biliary fistula and peritoneal fluid collection after operation are the key points in reducing postoperative hemorrhage.A timely and decisive reoperation is important to manage postoperative hemorrhage.

Objective To investigate the correlation between clinical manifestations (symptoms and signs) and pattern (disease location and nature) diagnosis in liver cancer based on association rules.Methods 1 042 patients with primary liver cancer were identified by using clinical epidemiological method.Medcase V3.2 was used to set up the dataset for the analysis of association between manifestations and patterns in liver cancer.Results Clinical manifestations such as right hypochondriac pain,upper right abdominal pain,abdominal distension,abdominal bulge,ascites,jaundice,loss of appetite,fatigue,greasy coating,and wiry pulse were more common in patients with liver cancer.The patterns of primary liver cancer appeared to be located mainly in the "liver,spleen,and gallbladder",and were closely related to "qi deficiency,qi stagnation,blood stasis,and dampness".Conclusion Correlation between clinical manifestations and patterns in liver cancer is present based on association rules.Given the ambiguity and complexity of TCM data,different data mining algorithms should be developed and applied to benefit TCM clinical practice.

Objective To investigate the application value of volumetric modulated arc therapy (VMAT) combined with zoledronic acid in treatment of vertebral metastases. Methods A total of 58 patients with vertebral metastasis in Qingdao Central Hospital from January 2015 to June 2017 were extracted according to simple random sampling method. The data of 58 patients were analyzed retrospectively, and they were divided into 2 groups according to the different radiotherapy technology. The study group (28 cases) received VMAT combined with zoledronic acid treatment, and the control group (30 cases) received general radiotherapy combined with zoledronic acid treatment. The efficacy and tissue damage of the patients in both groups were compared according to the evaluation criterion including the local control rate, pain relief rate, local progression-free survival rate and exposure of the spinal cord. Results The local control rates were 92.9 ％ (26/28) and 73.3 ％ (22/30) respectively in the study group and the control group (χ2= 3.869, P=0.049). The pain relief rates were 96.4 ％ (27/28) and 76.7 ％ (23/30) respectively (χ2= 4.757, P= 0.029). The local progression-free survival rates of 3-month were 85.7 ％ (24/28), 60.0 ％ (18/30) respectively (χ2=4.794, P= 0.029) and the local progression-free survival rates of 6-month were 78.6 ％ (22/28), 50.0 ％(15/30) in the study group and the control group (χ2=5.119, P=0.024). The exposure of the spinal cord was (29.80±0.88) Gy and (39.90±0.20) Gy, respectively (t= -61.083, P= 0.000). Conclusion VMAT combined with zoledronic acid can improve the local control rate, pain relief rate, local progression-free survival rate, and reduce the exposure of the spinal cord.

To investigate the changes of endocrine, cyclic nucleotide and immune systems in subjects of yang deficiency constitution, and to explore the relationship among characteristics and causes of yang deficiency constitution, the physiological and biochemical parameters.

In recent years,the application of machine learning in the field of radiotherapy has been gradually increased along with the development of big data and artificial intelligence technology.Through the training of previous plans,machine learning can predict the results of plan quality and dose verification.It can also predict the multi-leaf collimator (MLC) positioning error and linear accelerator performance.In addition,machine learning can be applied in the quality assurance of intensity-modulated radiotherapy to improve the quality and efficiency of treatment plan and implementation,increase the benefits to the patients and reduce the risk.However,there are many problems,such as difficulty in the selection,extraction and calculation of characteristic value,requirement for large training sample size and insufficient prediction accuracy,which impede its clinical translation and application.In this article,research progress on the application of machine learning in the quality assurance of IMRT was reviewed.

Machine learning has developed rapidly in recent years.Using machine learning to predict the radiotherapy outcomes and complications can more accurately evaluate the patients' conditions and take appropriate treatment measures as soon as possible.The non-dose and dose related factors generated during radiotherapy are filtered and input into the algorithm model,then corresponding prediction result can be obtained.There are many algorithm models to predict survival rate,tumor control rate and radiotherapy complications,and the predicted result are more accurate now.However,the algorithm model also has various problems,and it needs constant exploration and improvement.

Objective: To conduct a comprehensive and systematic review of the efficacy and safety of Wenxin Keli (WXKL) in the treatment of atrial fibrillation (AF) . Methods: Seven databases (PubMed, The Cochrane Library, Web ofScience, CNKI, Wanfang Database, VIP and SinoMed) were searched to identify relevant randomized controlled trials (RCTs) from inceptions to 1 October, 2018. Two review authors independently assessed the methodological quality andanalyzed data by Cochrane handbook and the Rev Man 5.3 software. Begg.s test was conducted to assess publication biasvia Stata 14 software. Results: Twenty-four RCTs with 2246 patients were included in this review. Compared with blankcontrol, placebo or western medicine alone, WXKL alone or combined with western medicine could effectively reducerapid ventricular rate (MD=-7.14, 95％CI:-8.42——5.87), the frequency and duration of AF. It could also shorten thesinus rhythm conversion time (MD=-3.04, 95％CI:-3.47——2.61), increase the sinus rhythm conversion rate (RR=1.19, 95％ CI: 1.09～1.29) and decrease recurrence rate of AF (RR=0.28, 95％ CI: 0.13-0.59) . Besides, WXKL alone orcombined with western medicine was beneficial for improving the left ventricular ejection fraction (LVEF) (MD=3.44, 95％ CI: 0.87-6.01), left ventricular end diastolic diameter (LVEDD) (MD=-2.47, 95％ CI:-2.86——2.08), left atrialdiameter (LAd) (MD=-0.91, 95％CI:-1.58——0.25) and P wave dispersion (Pd) (MD=-4.04, 95％CI:-4.15——3.93) .WXKL combined with low-dose amiodarone was superior to conventional-dose amiodarone alone in improving themaximum P wave (Pmax) (MD=-8.25, 95％ CI:-10.33——6.17), and WXKL combined with conventional-doseamiodarone is more effective (MD=-13.10, 95％CI:-13.65——12.55) . Compared with the control group, the treatmentgroup had fewer adverse reactions, and the Begg.s test did not find any publication bias. Conclusion: WXKL alone orcombined with western medicine exhibited better therapeutic effects in the treatment of AF, but these results still needhigh-quality evidence to verify.

Purpose To explore the clinicopathological features,diagnosis and differential diagnosis of large B-cell lym-phoma with IRF4 rearrangement(LBCL-IRF4r).Methods Clinical data of 8 cases of LBCL-IRF4r were collect,hematoxy-lin-eosin and immunohistochemical of EnVision two-step stains,in situ hybridization and FISH was used to study the histology,immunotypes and molecular genetic characteristics.The rele-vant literatures were reviewed.Results Among 8 cases of LBCL-IRF4r,the male to female ratio was 1.67:1,with age range 10-53 years(mean 25.8 years).Five cases occurred in tonsils,2 cases in nasopharynx and 1 cases in inguinal lymph node.Microscopically,the tumors presented with a purely follic-ular,purely diffuse or a combined follicular and diffuse architec-ture.The tumor cells were typical centroblasts and less frequent-ly medium-sized blastic cells with smaller nucleoli,apoptosis and nuclear fragmentation were easily seen.Immunophenotypi-cally,the tumor cells of the eight cases of LBCL-IRF4r diffuse strongly expressed CD20(8/8),PAX5(2/2),CD79a(3/3),BCL6(8/8)and MUM-1(8/8),mostly expressed CD10(7/8),partially expressed BCL2(5/8)and CD5(4/8),and did not express Cyclin D1,CD23 and CD30.The percentage of Ki67 index ranged from 70％to 95％.EBER in situ hybridiza-tion was negative in all cases.IRF4 rearrangements were detec-ted in all cases(8/8).BCL6 rearrangements were detected in one case(1/2).MYC(0/4)and BCL2(0/3)rearrangements were not detected in all cases.Conclusion LBCL-IRF4r is more common in children and adolescents with characteristic IG::IRF4 rearrangement and a good prognosis,which needs to be differentiated from other types of large B-cell lymphoma.

Immunological evasion is one of the defining characteristics of cancers, as the immune modification of an immune checkpoint (IC) confers immune evasion capabilities to tumor cells. Multiple ICs, such as programmed cell death protein-1 (PD-1) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), can bind to their respective receptors and reduce tumor immunity in a variety of ways, including blocking immune cell activation signals. IC blockade (ICB) therapies targeting these checkpoint molecules have demonstrated significant clinical benefits. This is because antibody-based IC inhibitors and a variety of specific small molecule inhibitors can inhibit key oncogenic signaling pathways and induce durable tumor remission in patients with a variety of cancers. Deciphering the roles and regulatory mechanisms of these IC molecules will provide crucial theoretical guidance for clinical treatment. In this review, we summarize the current knowledge on the functional and regulatory mechanisms of these IC molecules at multiple levels, including epigenetic regulation, transcriptional regulation, and post-translational modifications. In addition, we provide a summary of the medications targeting various nodes in the regulatory pathway, and highlight the potential of newly identified IC molecules, focusing on their potential implications for cancer diagnostics and immunotherapy.
Apoptosis Regulatory Proteins ; CTLA-4 Antigen/therapeutic use* ; Epigenesis, Genetic ; Humans ; Immunotherapy ; Neoplasms/therapy* ; Programmed Cell Death 1 Receptor/therapeutic use*