A three-dimensional(3D)medical image segmentation network(CA-SegResNet)which incorporates a 3D coordinate attention mechanism is proposed to address the issue of segmenting identified vertebral bones from spinal computed tomography(CT)images.The network extracts image features through a deep residual convolutional neural network and fuses the feature maps from each encoder layer with the input of the corresponding decoder layer.Subsequently,a 3D coordinate attention module is introduced to capture inter-channel relationships as well as directional and positional information,establishing long-range dependencies across different spatial directions,thereby enabling precise segmentation of the identified vertebral bones.For the segmentation tasks involving the identified cervical vertebra(the 7th cervical vertebra)and the identified thoracic vertebra(the 12th thoracic vertebra)across 105 cases,CA-SegResNet achieves average Dice similarity coefficients(DSC)of 0.934 5 and 0.918 9 on the test set,with average Hausdorff distances(HD)of 7 and 8 mm.Compared with U-Net results,the average DSC is improved by 0.014 5 and 0.0463,while average HD is reduced by 176 and 388 mm.The results demonstrate that the network can realize the precise segmentation of identified vertebral bones from CT images.

Progressive functional deterioration in the cochlea is associated with age-related hearing loss (ARHL). However, the cellular and molecular basis underlying cochlear aging remains largely unknown. Here, we established a dynamic single-cell transcriptomic landscape of mouse cochlear aging, in which we characterized aging-associated transcriptomic changes in 27 different cochlear cell types across five different time points. Overall, our analysis pinpoints loss of proteostasis and elevated apoptosis as the hallmark features of cochlear aging, highlights unexpected age-related transcriptional fluctuations in intermediate cells localized in the stria vascularis (SV) and demonstrates that upregulation of endoplasmic reticulum (ER) chaperon protein HSP90AA1 mitigates ER stress-induced damages associated with aging. Our work suggests that targeting unfolded protein response pathways may help alleviate aging-related SV atrophy and hence delay the progression of ARHL.
Mice ; Animals ; Transcriptome ; Aging/metabolism* ; Cochlea ; Stria Vascularis ; Presbycusis

Objective:To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) for neonatal refractory respiratory failure in a single medical center of Southwest China.Methods:From June 2020 to November 2021, the clinical data of neonates with refractory respiratory failure who received ECMO in the neonatal department of our hospital were retrospectively reviewed. The neonates were assigned into the survival group and the deceased group.Their general profile, clinical diagnosis, laboratory tests, ECMO operation, complications and prognosis were compared.Results:Eight neonates were included with five successfully withdrawal of ECMO and survived (5/8). For the three deceased neonates, two discontinued treatment because of intraventricular hemorrhage (grade Ⅲ~Ⅳ) and one confirmed congenital adrenal hyperplasia. No significant differences existed between the survival and the deceased groups in oxygenation index (OI), ECMO preparation and operation duration, usage of heparin, red blood cell suspension, platelet and sedative/analgesic drugs, therapeutic hypothermia and ECMO-associated complications. However, the deceased group had high OI values ( P=0.001), low lactate clearance ( P=0.005), more urine output during the first 24 h after ECMO ( P=0.046) and more fresh frozen plasma usage ( P=0.038). None of the five surviving children had significant developmental delay and neurological abnormalities during the 1-year follow-up. Conclusions:ECMO is effective treating neonatal refractory respiratory failure. Reducing the risk of intraventricular hemorrhage during ECMO may improve the survival rate.

Objective To select valuable biomarkers for diagnosis and predicting outcome of sepsis-related acute respiratory distress syndrome(ARDS) from D-dimmer (DD),yon Willebrand factor (vWF),platelet (PLT),N terminal-pro brain natriuretic peptide (NT-ProBNP),interleukin-6 (IL-6),interleukin-8 (IL-8) and surfactant protein D (SP-D).Methods A total of 48 sepsis accompanied with ARDS patients and 40 sepsis patients were prospectively studied with comparison.The clinical characteristics of all the patients were recorded in detail.The blood samples were obtained within 24 hours of ICU admission.The concentration or activity of the seven biomarkers was quantitatively assayed and the results were recorded.To select the most valuable biomarkers as clinical indices,diagnosis model and death predictive model were constructed by Logistic regression.Results Among the seven candidate biomarkers,SP-D,vWF and IL-8 showed the most value.Their area under the receiver operator characteristic curve (ROC) were 0.758 (P ＜ 0.01),0.783 (P ＜ 0.01) and 0.747 (P ＜ 0.01) respectively,and raised to 0.847 (P ＜ 0.001) when the three biomarkers were combined.IL-8,age greater than or equal to 60 years and APACHE Ⅱ score greater than or equal to 20 were related to ARDS death with 12.138(lnIL-8)(P=0.022),6.157(P=0.040) and7.415(P=0.014) of OR values respectively.Conclusion SP-D,vWF,IL-8 should be valuable for early prediction of sepsis-induced ARDS and the diagnostic accuracy raised through combined utilization.IL-8 may be predictable for prognosis of sepsis related ARDS and the comprehensive evaluation combining clinical indices with IL-8 should be suggested in clinical practice.

Objective To investigate the protective and therapeutic effect of chalcone ketones compound(code:L2H17,hereinafter referred to as L2)on mice infected with influenza A virus.Methods BALB/c mice were randomly divided into six groups:normal group,model group,positive drug-treated group,L2 treated groups (3 different concentrations).The mice were adapted for 72 hours,before a model was established by intranasal infection.Mice in each group were given medicine by i.g once daily for 6 days starting 24 h before virus challenge.Survival was observed daily for 14 days.The mortality,median survival time,rate of death protection and rate of prolonging life were determined to observe the therapeutic effect of chalcone(L2) against influenza virus infection.The whole lungs were taken under aseptic conditions on days 3 and 5 post-infection to calculat lung indexes and lung index inhibition.The left lung was fixed with 4% formaldehyde for pathological biopsy,the right lung was soaked in RNAstore to detect lung tissue viral load,and the double antibody sandwich ELISA method was used to detect the expression of inflammatory cytokines IL-6 and TNF-α in order to observe the therapeutic effect of L2 on viral pneumonia caused by influenza virus infection.Results Compared with the model group,the L2 80 mg/kg treatment group exhibited significant increases in median survival time(11 d),the rate of death protection (50%),and the rate of prolonging life(24.1%)but a moderate 50% decrease in mortality.In addition,the lung index decreased significantly both on d 3 and 5 after virus infection (P<0.05).The pathological results also improved significantly.The L2 80 mg/kg dose group had a significantly lower viral load of lung tissue on d 3 and 5 post-infection(P<0.05).Compared with model group,the expression of inflammatory factor IL-6 became lower to different degrees.Conclusion L2 has a protective effect on mice infected with influenza virus by reducing the degree of pathological changes of pneumonia caused by influenza viruses.

Objective To investigate the consensus and controversies on the delineation of radiotherapy target volume for patients with locally advanced non-small cell lung cancer (LA-NSCLC).Methods Questionnaires including 15 questions on the delineation of radiotherapy target volume of NSCLC were sent to 12 radiation departments in China in November 2015.A patient with LA-NSCLC was selected by Fudan University Shanghai Cancer Center, and simulation CT images and medical history data were sent to the 12 radiation departments.Twelve radiation oncologists from the 12 radiation departments showed and explained the delineation of radiotherapy target volume of their own, and the patient was discussed by all experts in the sixth multidisciplinary summit forum of precise radiotherapy and chemotherapy for tumor and lung cancer.Results All receivers of the questionnaire answered the questions.The standard lung window width/level for the delineation of lung cancer was 800-1600/-600 to-750 HU, and the mediastinum window was 350-400/20-40 HU.Respiratory movement was measured by stimulator, 4D-CT, and stimulator+4D-CT with 2-5 mm expansion based on experience.The primary clinical target volume (CTV) was defined as gross target volume (GTV) plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma.The metastatic lesion of mediastinal lymph nodes was delineated as 5 mm plus primary lesion in 6 departments and as primary lesion in another 6 departments.Of the 12 departments, 10 applied 5 mm of set-up error, 1 applied 3 mm, and 1 applied 4-6 mm.For V20 of the lungs, 10 departments defined it as<30%, 1 as<35%, and 1 as 28%.Nine departments defined the radiation dose of concurrent chemoradiotherapy (CCRT) for LA-NSCLC as 60 Gy in 30 fractions, 62.7 Gy in 33 fractions in 1 department, 50-60 Gy in 25-30 fractions in 1 department, and 60-70 Gy in 25-30 fractions in 1 department.For the delineation of target volume for the LA-NSCLC patient treated with CCRT, the primary planning target volume (PTV) was defined as GTV plus organ movement (IGTV) and set-up error (GTV→IGTV→PTV) in 3 departments, as CTV plus organ movement (ITV) and set-up error (GTV→CTV→ITV→PTV) in 8 departments, and as CTV plus set-up error/IGTV plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma (CTV) and set-up error (GTV→CTV→PTV/GTV→IGTV→CTV→PTV) in 1 department.For the delineation of PTV in the mediastinal lymph node, GTV→IGTV→PTV was performed in 3 departments, GTV→CTV→ITV→PTV in 8 departments, and GTV→CTV→PTV in 1 department.For 10%-100% patients with LA-NSCLC, the radiation field needed to be replanned when 38-50 Gy was completed.There was no unified standard for the optimal standardized uptake value (SUV) of positron emission tomography (PET)-computed tomography (CT) simulation and delineation.Seven departments had applied magnetic resonance imaging (MRI) simulation and 10 departments had applied stereotactic body radiation therapy (SBRT) for the treatment of early-stage NSCLC.For the delineation of PTV for early-stage NSCLC (T1-2N0M0), GTV→IGTV→PTV was performed in 5 departments, IGTV→PTV in 3 departments, and GTV→CTV→ITV→PTV in 2 departments.In all the 12 departments, peripheral early-stage NSCLC was given 6.0-12.5 Gy/fraction, 3-12 fractions and central early-stage NSCLC was given 4.6-10.0 Gy/fraction, 5-10 fractions.The results of discussion on the delineation of target volume for the patient were as follows:respiratory movements should be measured by 4D-CT or simulator;the lung window width/level is 1600/-600 HU and the mediastinal window width/level is 400/20 HU;the primary controversy is whether the involved-field irradiation or elective nodal irradiation should be used for the delineation of CTVnd in the mediastinal lymph node.Conclusions Basic consensus is reached for the delineation of target volume in LANSCLC in these aspects:lung window width/level, respiratory movements and set-up error, primary lesion delineation, the radiation dose in CCRT, and the optimal time for replanning the radiation field.There are controversies on the optimal SUV in the delineation of target volume based on PET-CT simulation, the optimal dose fractionation in SBRT for early-stage NSCLC, and the delineation of CTVnd.

Objective To analyze and summarize the treatment strategies for unstable angina with no-reflow phenomenon after PTCA during early percutaneous interventional procedures.Methods A total of 32 cases with unstable angina were divided into two groups:one group with drug therapy and the other group with drug therapy and thrombus aspiration catheter.The patients were chosen when there was no-reflow phenomenon after PTCA during early percutaneous interventional procedures and their clinical data were compared and analyzed.Blood flow TIMI grade,myocardial perfusion grade (MBG),TIMI myocardial perfusion (TMP) grade and other indexes were observed and recorded.Results The general conditions had no statistical difference between two groups.Compared with the drug therapy group,the proportion of patients with TIMI,MBG and TMP grade 3 was higher in aspiration and drug therapy group (89％ VS 71％ P＜0.05).Conclusion Drug therapy and thrombus aspiration catheter in treatment helps to improve myocardial perfusion level for unstable angina with no no-reflow phenomenon after PTCA during early percutaneous interventional procedures.

Objective:To observe the clinical efficacy of acupuncture plus moxibustion at Ciliao (BL 32) for primary dysmenorrhea (PD) due to cold-dampness. Methods:A total of 58 cases with PD due to cold-dampness were randomly allocated into an observation group (n=29) and a control group (n=29). Patients in the observation group were treated with acupuncture and suspended moxibustion at Ciliao (BL 32), whereas patients in the control group were treated with routine acupuncture alone. After three courses of treatment, the clinical efficacy was evaluated and compared between the two groups. Results:After treatment, the symptom scores were significantly reduced in both groups (P<0.05), but there were no significant between-group differences in clinical efficacy and symptom scores (P>0.05). Conclusion: With fewer points and less pain, acupuncture-moxibustion at Ciliao (BL 32) can obtain similar effect as routine acupuncture therapy for PD due to cold-dampness.

A patient with severe hypoglycemia due to insulin-like growth factor ( IGF)-IIsecreted by a giant solitary fibrous tumor of the pleura ( SFTP) was investigated through comprehensively reviewing his medical history and clinical records. The patient had severe hypoglycemia accompanied with significantly decreased serum insulin level. A solitary fibrous tumor of the pleura was found, and right pneumonectomy removed this giant tumor. Two years after the operation, the patient was fit and well with no further hypoglycemia episodes. Non-islet-cell tumor hypoglycemia should be considered in patients who have hypoglycemia episodes accompanied with significantly decreased serum insulin level.

Objective To investigate clinical effect of combined laparoscopic and endoscopic submucosal resection for the gastric antrum-body tumors originated from the muscularis propria.Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apr 2014.All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography.Endoscopy showed that the surface mucosa of tumors were normal in all patients.Tumors were found in the gastric antrum-body front wall in 4 cases,and in the back wall in 2 cases,and in the lesser omental bursa in 1 case,and in the greater omental bursa in 1 case.The tumors size was from 1.5 to 3.5 cm,averaging (2.4 ± 0.7) cm.The therapeutic procedure included three phases.The lesion was first exposed with laparoscopy.Then,the fluid was injected into the submucosa in the part of tumor by endoscopy.Finally the tumor was resected by laparoscopy.These patients were followed up and analyzed retrospectively.Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients.All tumors were resected completely.Sever bleeding,infection or death were not found in any patients.Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neurofibroma.All patients were followed up for 6 months,and there was no recurrent case.Gastric mucosa and function were normal in all patients.Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple,safe and effective method for gastric antrum-body tumors originated from the muscularis propria,and leads to little complication.