Objective To investigate the causes and management strategies for lower limb ischemic necrosis following xenogeneic heterotopic heart transplantation from a multigene-edited pig to a rhesus monkey. Methods A xenogeneic heterotopic heart transplantation was performed on December 16, 2023, at the Institute of Experimental Animals of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, using a quintuple-gene-edited pig as the donor and a rhesus monkey as the recipient. On postoperative day (POD) 9, the recipient monkey underwent left lower limb amputation due to ischemic necrosis. Blood samples were collected at various time points after transplantation for analysis of hematologic parameters, liver and renal function, myocardial enzymes, and coagulation profiles. Ultrasound and computed tomography (CT) were used to evaluate anastomotic patency and cardiac structure. Immunological assays, including complement-dependent cytotoxicity (CDC) and IgG/IgM antibody detection, combined with clinical observations, were employed to assess rejection type and therapeutic response. Results The recipient monkey survived for 46 days after transplantation. Echocardiography demonstrated preserved biventricular systolic function in the recipient’s native heart, with left ventricular ejection fraction (LVEF) consistently exceeding 50%. In the donor pig heart, left ventricular endocardial thickening was noted on POD 9, followed by right ventricular endocardial thickening on POD 24, while LVEF remained around 35%. No hyperacute or acute rejection was detected immunologically. CDC positivity ranged between 3.4% and 5.1%, with IgG/IgM antibody binding trends consistent with CDC results. Following amputation, the recipient exhibited elevated inflammatory markers, coagulopathy, and reactive thrombocytosis, which later normalized. Immunohistochemical staining of the necrotic limb revealed arterial and venous thrombosis; however, no T-cell or B-cell infiltration was observed in vascular structures, thrombi, nerves, muscles, fascia, or skin tissues, with CD3 and CD20 staining both negative. Conclusion Limb ischemia after xenogeneic heart transplantation may be associated with lower extremity vascular thrombosis triggered by local trauma in the context of transplantation-induced inflammatory activation and coagulation dysfunction. While no clear lymphocyte-mediated rejection was observed, further studies are needed to explore the potential role of non-lymphocyte-mediated immune mechanisms.

This article is based on modern psychology and TCM emotional theory,combined with facial expression recognition technology,to apply deep learning methods to the digital research of TCM emotions to more accurately capture and analyze patients'emotional states.A cross-disciplinary framework was established by synthesizing facial expression-emotion correlations from psychological and TCM perspectives.The methodology included:Data annotation of TCM-defined emotional expressions using standardized coding systems;Facial expression acquisition,spatiotemporal feature extraction and emotion classification through a 3D convolutional neural network(3D CNN).The framework achieved 91.43%accuracy in video-based emotion classification.High-arousal emotional states demonstrated superior recognition performance,with anger showing optimal recall(1.000 0)and F1-score(0.946 3),while surprise attained the highest precision(0.976 0).These findings aligned with TCM pathological characteristic of"anger induces qi ascending,surprise disrupts qi flow".The digital recognition framework for TCM emotional quantification based on facial expression recognition technology exhibits strong alignment with TCM observation diagnosis,providing clinicians with an objective tool to assess the"seven emotions"and elucidating emotion-facial correlations in classical TCM theory.Future research should focus on longitudinal validation across diverse populations and establish development pathways for AI-assisted TCM diagnostic systems.

Objectives:To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforami-nal lumbar interbody fusion(MO-TLIF)in the treatment of degenerative lumbar diseases in the elderly.Meth-ods:A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020.Among them,37 were male and 25 were female,aged 68.0±5.5 years.The patients were divided into the MO-TLIF group(32 cases)and the MIS-TLIF group(30 cases).There were no statistically significant differences between the two groups in terms of gender ratio,age,body mass index(BMI),surgical segment,disease duration,or follow-up time(P＞0.05).The differences between the two groups were compared in terms of operative time,in-traoperative blood loss,intraoperative fluoroscopy,postoperative wound drainage,time to ambulation,hospital stay,complications,and fusion rate.The visual analogue scale(VAS),lumbar Japanese Orthopedic Association(JOA)scores,and Oswestry disability index(ODI)before surgery,at 3 months postoperatively,and at the final follow-up were recorded and compared.Results:The two groups of patients all successfully completed the surgery without significant surgery-related complications.There were no statistically significant differences be-tween the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs.72.3±21.8mL),postoperative wound drainage volume(30.7±10.2mL vs.29.3±9.0mL),or hospital stay(5.4±0.9d vs.5.4±0.8d)(P＞0.05).Compared with the MIS-TLIF group,the MO-TLIF group had shorter operative time(90.8±8.8min vs.98.3±8.0min,P=0.001)and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs.7.2±1.4 times,P＜0.001).Both groups showed significant improvement in low back pain VAS score,lumbar JOA score,and ODI at postoperative 3 months and final follow-up compared with preoperative values(P＜0.001),but there were no statistically significant differences between the two groups at the same time points(P＞0.05).At the fi-nal follow-up,no internal fixation-related complications such as screw or rod breakage were observed in both groups,and all the cases achieved bone fusion.Conclusions:Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases,which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.

Objectives:To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforami-nal lumbar interbody fusion(MO-TLIF)in the treatment of degenerative lumbar diseases in the elderly.Meth-ods:A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020.Among them,37 were male and 25 were female,aged 68.0±5.5 years.The patients were divided into the MO-TLIF group(32 cases)and the MIS-TLIF group(30 cases).There were no statistically significant differences between the two groups in terms of gender ratio,age,body mass index(BMI),surgical segment,disease duration,or follow-up time(P＞0.05).The differences between the two groups were compared in terms of operative time,in-traoperative blood loss,intraoperative fluoroscopy,postoperative wound drainage,time to ambulation,hospital stay,complications,and fusion rate.The visual analogue scale(VAS),lumbar Japanese Orthopedic Association(JOA)scores,and Oswestry disability index(ODI)before surgery,at 3 months postoperatively,and at the final follow-up were recorded and compared.Results:The two groups of patients all successfully completed the surgery without significant surgery-related complications.There were no statistically significant differences be-tween the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs.72.3±21.8mL),postoperative wound drainage volume(30.7±10.2mL vs.29.3±9.0mL),or hospital stay(5.4±0.9d vs.5.4±0.8d)(P＞0.05).Compared with the MIS-TLIF group,the MO-TLIF group had shorter operative time(90.8±8.8min vs.98.3±8.0min,P=0.001)and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs.7.2±1.4 times,P＜0.001).Both groups showed significant improvement in low back pain VAS score,lumbar JOA score,and ODI at postoperative 3 months and final follow-up compared with preoperative values(P＜0.001),but there were no statistically significant differences between the two groups at the same time points(P＞0.05).At the fi-nal follow-up,no internal fixation-related complications such as screw or rod breakage were observed in both groups,and all the cases achieved bone fusion.Conclusions:Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases,which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.

This article is based on modern psychology and TCM emotional theory,combined with facial expression recognition technology,to apply deep learning methods to the digital research of TCM emotions to more accurately capture and analyze patients'emotional states.A cross-disciplinary framework was established by synthesizing facial expression-emotion correlations from psychological and TCM perspectives.The methodology included:Data annotation of TCM-defined emotional expressions using standardized coding systems;Facial expression acquisition,spatiotemporal feature extraction and emotion classification through a 3D convolutional neural network(3D CNN).The framework achieved 91.43%accuracy in video-based emotion classification.High-arousal emotional states demonstrated superior recognition performance,with anger showing optimal recall(1.000 0)and F1-score(0.946 3),while surprise attained the highest precision(0.976 0).These findings aligned with TCM pathological characteristic of"anger induces qi ascending,surprise disrupts qi flow".The digital recognition framework for TCM emotional quantification based on facial expression recognition technology exhibits strong alignment with TCM observation diagnosis,providing clinicians with an objective tool to assess the"seven emotions"and elucidating emotion-facial correlations in classical TCM theory.Future research should focus on longitudinal validation across diverse populations and establish development pathways for AI-assisted TCM diagnostic systems.

Objective:To observe the lipid-lowering effect of atorvastatin on patients with acute cerebral infarction with different ATP-binding cassette subfamily B member 1(ABCB1) genotypes, and thus to provide clinical research evidence for individual application of atorvastatin in patients with acute cerebral infarction.Methods:From March 2021 to December 2021, 131 patients with acute cerebral infarction admitted to the Department of Neurology of Xuchang Central Hospital were included. The ABCB1 G2677T gene polymorphism rs2032582 of patients was detected by fluorescence staining in situ hybridization.Based on the detection results, patients were divided into GG group, GT group and TT group.All patients were given atorvastatin (20 mg/d) for lipid-lowering treatment.The levels of low density lipoprotein cholesterol(HDL-C), high density lipoprotein cholesterol(HDL-C), total cholesterol(TC)and triglyceride(TG) in serum of patients in the three groups before and 2 months after treatment were recorded and analyzed.The adverse drug reactions in the three groups were recorded. When the serum LDL-C level was less than 1.8 mmol/L, it was considered that the lipid-lowering treatment was effective.The binary Logistic regression analysis was used to explore the influencing factors of atorvastatin lipid lowering therapy.The software of SPSS 25.0 was used for statistical analysis.Results:There were 50 (38.17%), 49 (37.40%) and 32 (24.43%) patients in GG group, GT group and TT group, respectively. The serum TC levels of patients in GG group, GT group and TT group after treatment were (3.47±0.70) mmol/L, (3.59±1.09) mmol/L and (3.48±1.02) mmol/L, respectively, which were lower than those before treatment ((4.27± 0.99) mmol/L, (4.02±0.98) mmol/L and (4.03±1.31) mmol/L), all of which were statistically significant ( t=7.652, 3.092, 5.593, all P<0.01). The serum LDL-C levels in GG group, GT group and TT group after treatment were (1.89±0.53) mmol/L, (2.07±0.92) mmol/L and (1.96±0.79) mmol/L, respectively, which were lower than those before treatment ((2.87±0.92) mmol/L, (2.56±0.89) mmol/L and (2.55±1.11) mmol/L) ( t=9.896, 4.055, 5.980, all P<0.001). The differences of serum LDL-C level before and after treatment in GG group, GT group and TT group were (-0.97±0.69) mmol/L, (-0.50±0.86) mmol/L and (-0.59±0.56) mmol/L, respectively. The difference of serum LDL-C level before and after treatment in the three groups was statistically significant ( F=5.614, P=0.005). The difference of TC, TG and HDL-C before and after treatment was not statistically significant( F=2.783, 0.490, 1.677, all P>0.05). The binary Logistic regression analysis showed that ABCB1 G2677T gene type and staying up late were independent influencing factors for atorvastatin lipid-lowering therapy. The probability of effective lipid-lowering in GT patients with ABCB1 G2677T gene was 27.9% of that in GG patients ( OR=0.279, 95% CI: 0.110-0.709, P=0.007), and the probability of TT type patients was 33.8% of GG type patients ( OR=0.338, 95% CI: 0.121-0.943, P=0.038). The probability of effective lipid-lowering in patients who had the habit of staying up late was 26.4% of the patients who did not stay up late ( OR=0.264, 95% CI: 0.118-0.591, P=0.001). There was no significant difference in the total incidence of adverse drug reactions among the three groups( χ2=0.868, P=0.648). Conclusion:The lipid-lowering effect in patients with GG type of ABCB1 G2677T is better than that of GT type and TT type when atorvastatin is used to treat patients with acute cerebral infarction.

Objective:To explore the detection and segmentation of ischemic core infarct volume of the acute stroke in diffusion weighted imaging (DWI) images using cascaded VB-Net.Methods:MRI data of 1 500 patients (2 456 lesions) with acute ischemic stroke in Henan Provincial People′s Hospital from December 2016 to December 2018 were retrospectively analyzed. Firstly, manual segmentation of ischemic core was performed on DWI images (b=1 000 s/mm 2), and then all data were divided into training set, validation set and independent test set by 8∶1∶1. Then, the cascaded VB-Net was constructed, and the core infarct was automatically detected and segmented in the test set. Interclass correlation coefficient (ICC) was used to evaluate the consistency of volume size measured by manual segmentation and cascaded VB-Net. The patients were divided into large ischemic core lesion group (ischemic core volume ≥10 ml) and small ischemic core lesion group (ischemic core volume<10 ml), and the Dice coefficient difference between the two groups was compared using Mann-Whitney U test. Results:In independent test set, cascaded model had the detection rate of 94.6% (243/257) with Dice coefficient of 0.76 (0.68, 0.84). The agreement of cacade VB-Net segmented [4.19(1.21,14.13)ml] and manual segmented ischemic core infarct volume [4.08(1.19,17.92)ml] was high (ICC=0.97, P<0.001). There was no significant difference in Dice coefficient between large and small lesion groups [0.76 (0.69, 0.85), 0.76 (0.67, 0.84), Z=-0.44, P=0.657]. Conclusions:The cascaded VB-Net model provided a tool to realize automatic detection, segmentation, and calculation of ischemic core infarct volume. It has good segmentation accuracy and high consistency with manual segmentation, which can provide an auxiliary decision-making tool for the selection of treatment plans.

Objective:To investigate the influence of effects of transarterial chemoembo-lization (TACE) before liver transplantation on the prognosis of hepatocellular carcinoma.Methods:The retrospective cohort study was conducted. The clinicopathological data of 311 hepatocellular carcinoma patients undergoing TACE before liver transplantation who were admitted to the Third Medical Center of Chinese PLA General Hospital from January 2005 to December 2012 were collec-ted. There were 276 males and 35 females, aged from 47 to 59 years, with a median age of 52 years. All the 311 patients underwent TACE before liver transplantation. Observation indicators: (1) effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors; (2) follow-up; (3) influencing factors for prognosis of hepatocellular carcinoma patients after liver transplantation. Follow-up was conducted using outpatient examination or telephone interview to detect recurrence and metastasis of tumor and survival and graft loss of patients up to December 2017. The patients were followed up every 2 to 4 weeks within 3 months after liver transplantation, and once every 1 to 3 months thereafter. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the nonparametric rank sum test. The COX regression model was used for univariate and multivariate analyses. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-rank test was used for survival analysis. Results:(1) Effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors. Of the 311 patients undergoing TACE, 57 cases had pathologic complete response (pCR) and 254 cases had pathologic partial response (pPR), respectively. Cases with alpha fetoprotein (AFP) <20 μg/L,20?400 μg/L, >400 μg/L, cases with microvascular invasion, cases with tumor number as single nodule, cases with tumor distribution at right lobe of liver, cases with tumor caliber of feeding artery (CFA) >1 mm were 26, 26, 5, 51, 6, 43, 46 in patients with pCR, versus 87, 64, 103, 158, 59, 125, 159 in patients with pPR, showing significant differences in the above indicators ( Z=3.35, χ2=4.54, 15.71, 12.89, 6.79, P<0.05). (2) Follow-up. All the 311 patients were followed up for 47.0 to 59.0 months, with a median follow-up time of 44.6 months. There were 11 cases undergoing tumor recurrence and 11 cases undergoing tumor metastasis in the 57 patients with pCR, and there were 96 cases undergoing tumor recurrence and 66 cases under-going tumor metastasis in the 254 patients with pPR. The 1-, 3-, 5-year tumor recurrence free rates were 98.2%, 91.1%, 80.3% in the 311 patients, respectively. The 1-, 3-, 5-year tumor recurrence free rates were 100.0%, 91.1%, 80.3% in the 57 patients with pCR, versus 82.0%, 68.4%, 59.4% in the 254 patients with pPR, showing significant differences in the above indicators ( χ2=13.47, P<0.05). Cases with graft loss were 11 and 96 in the 57 patients with pCR and the 254 patients with pPR, respectively, showing a significant difference ( χ2=7.06, P<0.05). (3) Influen-cing factors for prognosis of hepatocellular carci-noma patients after liver transplantation. Results of univariate analysis showed that gender, basic diseases as viral hepatitis C, AFP (20?400 μg/L, >400 μg/L), Milan criteria, microvascular invasion, tumor number, tumor distribution, tumor CFA, times of TACE, effects of TACE were related factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.49, 3.97, 1.78, 1.84, 2.41, 1.96, 3.00, 1.76, 0.19, 2.01, 3.07, 95% confidence interval as 0.30?0.81, 2.23?7.05, 1.03?3.06, 1.18?2.85, 1.63?3.56, 1.28?3.01, 2.04?4.40, 1.20?2.59, 0.13?0.28, 1.28?3.14, 1.63?5.76, P<0.05). Results of multi-variate analysis showed that AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR were independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=1.59, 2.06, 1.99, 2.05, 95% confidence interval as 1.22?2.07, 1.35?3.13, 1.29?3.07, 1.02?4.10, P<0.05) and tumor CFA >1 mm was an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.10, 95% confidence interval as 0.05?0.19, P<0.05). Conclusions:The effects of TACE are related to AFP, microvascular invasion, tumor number, tumor distribution and tumor CFA. AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR are independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation and tumor CFA >1 mm is an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation.

Objective:To investigate the value of quantitative parameters derived from dual-layer spectral detector CT (SDCT) in characterizing regional lymph node (LN) status of colorectal cancer.Methods:From August 2019 to May 2020, 101 patients with colorectal cancer confirmed by pathology in the First Affiliated Hospital of Sun Yat-sen University were retrospectively collected. The largest regional LNs were matched with surgical pathology one by one and divided into metastatic LNs group (42 cases) and nonmetastatic LNs group (59 cases) according to pathological results. Based on preoperative venous phase contrast enhanced SDCT images he short-axis diameter (S) and the of the largest regional LN was measured, then its border and enhancement homogeneity were evaluated. Outlining the ROI along the edge of the LN on its widest cross section, the iodine density (ID) and effective atomic number (Z eff) were measured, then the normalized ID (nID) and normalized Z eff (nZ eff) were calculated. The χ 2 test, Fisher′s exact test, independent samples t-test or Mann-Whitney U test were used to compare the differences of each parameter between pathologically metastatic and nonmetastatic LNs and a logistic regression model was constructed. The ROC curves and area under the curve (AUC) were performed to evaluate the diagnostic performance of each parameter. DeLong test was used to compare the differences of each AUC. Results:The S, border, enhancement homogeneity, ID, Z eff, nID and nZ eff of LNs all showed significant differences between metastatic and nonmetastatic LNs (all P<0.001). The regression model constructed by S and Z eff of LNs had the highest value in differentiating metastatic and nonmetastatic LNs, with an AUC of 0.935, sensitivity and specificity of 85.7% and 89.8%, respectively. Its diagnostic value was higher than that of S, border, enhancement homogeneity (AUC 0.674-0.832, all P<0.05) and SDCT quantitative parameters (AUC 0.863-0.906, all P<0.05) of LNs. Conclusion:SDCT quantitative parameters facilitate the accurate diagnosis of regional metastatic LNs in patients with colorectal cancer, among which the multi-parameter regression model has the highest diagnostic value.

Objective: To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT). Methods: From January 2016 to June 2017, 62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively, including 33 in the individualized group and 29 in the experience group. All patients were diagnosed by Color Doppler Ultrasound (CDUS). Gender, age, the results of the initial international standardized ratio (INR) measurement, the time from the first dose to the INR standard, and whether the INR exceeds the standard in the process of increasing the dose were collected. Results: There was no significant difference in sex, age and initial INR between the two groups (P>0.05). The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8±6.8)d vs (17.6±7.5)d, P<0.05]; There was no significant difference in INR between the two groups (P=0.377). Conclusions For the patients with DVT for the first time, the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding.