Duodenum-preserving pancreatic head resection， also known as Beger surgery， has a high incidence rate of bile duct injury after surgery， while the treatment modality for bile duct injury depends on the severity of the injury， and endoscopic therapy is often challenging in case of severe bile duct injury. Recently a patient with biliary fistula after Beger surgery was admitted to Affiliated Hangzhou First People’s Hospital， Westlake University， and successful diagnosis and treatment were achieved through oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique.

ObjectiveTo investigate the effect and underlying mechanism of the Wulao Qisun prescription on pathological new bone formation in ankylosing spondylitis （AS）. MethodsSynovial fibroblasts were isolated from the hip joints of AS patients and observed under a microscope to assess cell morphology. The cells were identified using immunofluorescence staining. The isolated AS fibroblasts were divided into blank group， low drug-containing serum group， medium drug-containing serum group， high drug-containing serum group， and positive drug group. After drug intervention， cell proliferation was measured using the cell counting kit-8 （CCK-8） assay to observe fibroblast growth and determine the optimal intervention time. Alkaline phosphatase （ALP） activity was measured using the alkaline phosphatase assay. Protein expression of osteocalcin （OCN）， osteopontin （OPN）， and runt-related transcription factor 2 （Runx2） was detected by Western blot. The mRNA expression levels of Wnt5a， β-catenin， and Dickkopf-1 （DKK-1） were measured by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， each drug-containing serum group of Wulao Qisun prescription and the positive drug group inhibited the proliferation of AS fibroblasts and reduced ALP expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription downregulated β-catenin mRNA expression （P<0.05）. The medium and high drug-containing serum groups and the positive drug group significantly downregulated Wnt5a and β-catenin mRNA expression （P<0.05， P<0.01）， with the positive drug group showing the most pronounced effect （P<0.01）. The high drug-containing serum group and the positive drug group significantly upregulated DKK-1 mRNA expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription inhibited the expression of OPN and Runx2 proteins （P<0.05， P<0.01）， while the medium and high drug-containing serum groups and the positive drug group inhibited the expression of OCN， OPN， and Runx2 proteins （P<0.05， P<0.01）. ConclusionThe Wulao Qisun prescription can inhibit the proliferation and osteogenic differentiation of AS fibroblasts， thereby delaying the formation of pathological new bone in AS. The possible mechanism involves the regulation of Wnt/β-catenin-related gene expression， further inhibiting the transcription of downstream target genes.

This paper reviews the published articles of recent years on the application of deep learning methods in automatic localization of acupoint, and summarizes it from 3 key links, i.e. the dataset construction, the neural network model design, and the accuracy evaluation of acupoint localization. The significant progress has been obtained in the field of deep learning for acupoint localization, but the scale of acupoint detection needs to be expanded and the precision, the generalization ability, and the real-time performance of the model be advanced. The future research should focus on the support of standardized datasets, and the integration of 3D modeling and multimodal data fusion, so as to increase the accuracy and strengthen the personalization of acupoint localization.
Deep Learning ; Acupuncture Points ; Humans ; Neural Networks, Computer

The paper introduces Professor LIU Zhibin's clinical experience in treatment of Parkinson's disease with constipation by the combined therapy of acupuncture and tuina. Professor LIU believes that constipation in Parkinson's disease involves pathological changes in sanjiao (triple energizers) system, i.e. upper, middle, and lower jiao, and proposes Tiaoshen Tongfu (regulating the mind and fu organs) acupuncture and Chang'an Liu's tuina manipulation are used to treat Parkinson's disease with constipation based on the "sanjiao theory". In acupuncture, the scalp points of the anterior hairline micro-acupuncture system (Touxue, Shangjiao, Zhongjiao and Xiajiao) are selected, complemented by Baihui (GV20), Hegu (LI4), Taichong (LR3), Quchi (LI11), Tianshu (ST25), Dachangshu (BL25), Shangjuxu (ST37) and Zhigou (TE6). In tuina manipulation, one finger pushing, rolling and pressing are adopted.
Humans ; Constipation/physiopathology* ; Parkinson Disease/physiopathology* ; Acupuncture Therapy ; Acupuncture Points ; Male ; Female ; Middle Aged

This paper presents an automatic acquisition and analytic procedure of acupuncture manipulation based on optical navigation, aiming at solving the shortcomings of existing acquisition methods of acupuncture manipulation. An acquisition holder installed at the handle tail of filiform needle was designed to display the movement trajectory of the needle during acupuncture delivery by collecting the movement trajectory of holder. The 3-month old male Bama miniature pig was selected as the experimental subject, and 6 points, "Bojian" "Qiangfeng" "Housanli" "Xiaokua" "Huiyang" (BL35) and "Baihui" (GV20), were selected during acupuncture manipulation. The optical navigation system was used to collect the real-time data, and these data were per-processed and analyzed using mean filtering and Fourier transform. The acupuncture procedure was divided into 3 stages, inserting, lifting-thrusting, and twisting. The results showed that the accuracy was 96.3% at lifting-thrusting stage, and that was 100.0% at twisting stage. The decomposition effect of the entire procedure was satisfactory. This study provides a new approach to the quantitative analysis of acupuncture manipulation. In the future, it needs to further optimize the algorithm and expand the sample size so as to improve the accuracy of this analytic technique.
Acupuncture Therapy/methods* ; Male ; Animals ; Swine ; Acupuncture Points ; Humans ; Swine, Miniature ; Needles

Objective To explore the prognostic impact of Qili Qiangxin capsules(QLQX)in patients with ST-segment elevation myocardial infarction(STEMI).Methods Retrospective collecting the clinical data of STEMI patients treated at PingAn Hospital affiliated to Hebei Medical University from January 2020 to January 2022,divided into QLQX group and non-QLQX group according to treatment plan.Follow-up patients for 1 year,with the main endpoint being major adverse cardiovascular and cerebrovascular events(MACCEs)at 30 d and 1 year;The secondary endpoints were cardiogenic death,myocardial reinfarction,emergency coronary revascularization,stroke,and major bleeding at 30 d and 1 year,as well as severe STEMI complications(30 d),re-admission due to heart failure(1 year),and all-cause mortality(1 year).Results A total of 210 STEMI patients were included(125 in the QLQX group and 85 in the non QLQX group).Univariate or Kaplan Meier analysis showed that the MACCE,cardiogenic death,malignant arrhythmia at 30 d,myocardial reinfarction,re-admission due to heart failure,and all-cause mortality rates in the QLQX group were significantly lower than those in the non QLQX group at 30 d and 1 year(P＜0.05),while there were no significant differences in the incidence of other observed endpoint events between the two groups(P＞0.05).In addition,QLQX may be a protective factor for MACCEs in STEMI patients(30 d:HR=0.157,95％CI 0.032 to 0.756,P=0.021;1 year:HR=0.208,95％CI 0.087 to 0.497,P=0.014).Conclusion QLQX adjuvant therapy may improve MACCEs in STEMI patients.

Objective:To investigate the value of CT imaging radiomics in predicting the therapeutic effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.Methods:The clinical data of 167 patients with pancreatic duct stones treated with ESWL in the Department of Gastroenterology, the First People's Hospital of Hangzhou, Westlake University from July 2016 to January 2023 were retrospectively analyzed. Patients were divided into complete lithotripsy group (stone diameter ≤3 mm, n=94) and incomplete lithotripsy group (stone diameter>3 mm, n=73), according to the size of the largest residual stone after the first ESWL treatment. ITK SNAP software was used to delineate the images of pancreatic duct stones, and the artificial intelligence tool kit developed by United Shadow Company was used to extract the image radiomics characteristics. The pancreatic duct stone data set was randomly assigned into the training set ( n=118) and the test set ( n=29) in the ratio of 8∶2, and the absolute maximum normalization treatment was used, followed by peacekeeping selection through the minimum absolute contraction and selection operator (Lasso) to calculate the CT image radiomics score, and the logistic regression classifier was used to construct the ESWL treatment effect prediction model of pancreatic duct stones. Receiver operating characteristic curves (ROC) were plotted, and the area under the curve (AUC) and sensitivity, specificity, and accuracy were calculated to assess the performance of the prediction model. Decision curve analysis was used to evaluate the clinical value of CT radiomics score in the diagnosis of ESWL for pancreatic duct stones. Results:A total of 2 287 imaging radiomics characteristics were extracted, and 11 optimal imaging radiomics characteristics were finally screened by Lasso regression dimensionality reduction to establish a prediction model for ESWL treatment effect of pancreatic duct stones. The AUC values of the training set and the test set were 0.89 and 0.87, respectively, and the sensitivity, specificity, and accuracy were 82% and 79%, 82% and 82%, 82% and 80%, respectively. The AUC value in the independent validation set was 0.90, and the sensitivity, specificity, and accuracy were 78%, 90%, and 85%, respectively. The results of decision curve analysis showed that when the probability of ESWL efficacy in the diagnosis of pancreatic duct stones with CT image radiomics score was >0.05, the use of CT image radiomics score in the diagnosis of ESWL efficacy in pancreatic duct stones was more beneficial to patients in clinical practice than not.Conclusions:The treatment effect of ESWL for pancreatic duct stones can be predicted by CT imaging radiomics model.

Background and purpose:Deep learning methods can be used for automatic segmentation and detection of lymphocytes on pathological images.This study aimed to assess the performance of using variational autoencoding pre-training method for lymphocyte infiltration detection on pathological images,as well as the impact of removing tumor necrosis regions on model performance.Methods:Using variational autoencoding(VAE)pre-training method,pre-training was performed on a large number of unlabeled pathological images from the Cancer Genome Atlas(TCGA)database(TCGA-COAD and TCGA-READ)to obtain an auto-encoding pre-training model,and then a classifier model of lymphocyte infiltration was trained on the public data samples.To avoid confusion with necrotic regions,a Unet segmentation model for tumor necrotic regions was trained to remove the influence of tumor necrotic regions on lymphocyte identification.Results:The lymphocyte infiltration detection model pre-trained with the VAE model had an area under curve(AUC)of 0.979(95%CI:0.978-0.980),an accuracy of 92.5%(95%CI:92.3%-92.6%),a kappa value of 0.849,sensitivity of 0.908,specificity of 0.941,precision of 0.939,recall of 0.908,and F1 of 0.923 under the receiver operating characteristic(ROC)curve on the training set.The AUC for the validation set was 0.968(95%CI:0.964-0.972),the accuracy was 91.3%(95%CI:90.6%-92.0%),kappa value was 0.826,sensitivity was 0.898,specificity was 0.928,precision was 0.925,recall was 0.898,and F1 was 0.912.The results of Resnet18 model on the labeled dataset were as follows:accuracy of the validation set was 83.2%(95%CI:82.2%-84.1%),kappa value was 0.664,sensitivity was 0.823,specificity was 0.840,precision was 0.838,recall was 0.823 and F1 was 0.830.The Unet model that segmented the necrotic regions of the tumors had a final DICE of 0.78 for the training set,and 0.76 for the validation.After removing the necrotic region,the predictive performance of the pre-trained lymphocyte infiltration detection model using the VAE proposed in this article was improved to some extent,with the AUC on the validation set increasing from 0.968(95%CI:0.964-0.972)to 0.971(95%CI:0.968-0.975).The accuracy was 92.4%(95%CI:91.7%-93.0%),kappa value was 0.849,sensitivity was 0.928,specificity was 0.921,precision was 0.921,recall was 0.928,and F1 was 0.925.Conclusion:Using the variational autoencoding model pre-training method to classify the pathological pictures of lymphocyte infiltration can obtain better model performance compared with direct training,and removing the influence of tumor necrosis areas through Unet can further improve the performance of the model.

With the widespread application of diving technology, the safety of long-term diving has become a research focus. Research on the chronic health effects of long-term diving on divers mainly focuses on the respiratory system, circulatory system, nervous system, skeletal system, urinary system, as well as psychological health and sleep. Long-term diving can lead to increased lung capacity, thickening of nasal mucosa, myocardial hypertrophy, changes in heart rhythm, and hearing loss in divers. The impact of long-term diving on health is influenced by diving exposure index such as diving mode, maximum diving depth, underwater stay time, diving frequency, and number of dives, as well as individual factors such as years of diving experience, age, and medical history of divers. However, research on the effects of diving on health are inconsistent, and the potential mechanisms of health damage are unclear. Future large-scale research should be conducted under strict experimental conditions and with standardized inclusion criteria for subjects. Establishing a scientific and systematic assessment method for decompression is crucial for studying the chronic health effects of divers and enhancing understanding of relevant mechanisms to promote the development of diving industry and sport.

Hydration status refers to the balance between the intake and discharge of water in the body. When the ingested and discharged water are roughly equal and the body is in water balance, it is the normal hydration status, and when the water intake is too little or too much, it is the "dehydration" or "overhydration status". The hydration status of the body not only affects metabolism, but also affects the functions of the urinary system, cardiovascular system, nervous system, etc. In order to further clarify the relationship between body hydration status and decompression sickness (DCS), this paper reviewed relevant studies and analyzed the interaction between hydration and decompression safety during diving. The primary causes of dehydration in diving are "hyperbaric diuresis", "immersion diuresis", breathing dry gas, heat, and cold. Dehydration not only promotes the occurrence of DCS but also reduces the aerobic work efficiency and athletic performance of divers, as well as affects cognition and mood. A study found that appropriate rehydration before and during diving can reduce the risk of DCS, which possibly associates with the increase of blood volume, plasma surface tension, and vasoconstriction. Fluid therapy is also important for those who already have DCS. This paper analyzed the amount, nature, timing, and effect of rehydration involved in the above links, comprehensively sorted out the relationship between hydration and diving safety, summarized the existing problems, and provided reference for practical application and future research.