Objective:To study the optimal anastomotic angle of end-to-side anastomosis autogenous arteriovenous fistula (AVF).Methods:A case-report and case-series design was used to obtain clinical data on 10 patients with diabetic nephropathy from Department of Nephrology, the 905th Hospital of the Chinese People′s Liberation Army Navy from June 2024 to February 2025. The models of "radial artery-cephalic vein" end-to-side anastomosis in the forearm with anastomotic angles of 30°, 40°and 50°were established. Numerical simulation was used to analyze the blood flow in the model, and to study the effect of different anastomotic angles on blood flow. Wall shear stress (WSS), cross section flow velocity and flow rate, and relative residence time (RRT) were studied in the model. The Whitney test with Holm correction was used to evaluate the difference in the median RRT between the three angle models.Results:At the moment of 0.65 s, the area fraction of low wall shear stress (LWSS) in the 30° model was 7.7%, which was reduced by 2.4% and 3.7% compared to the 40°and 50°models, respectively. At the time of 0.2 s, the area proportions of high wall shear stress (HWSS) in the 30°, 40°and 50°models were 54.4%, 43.9% and 37.4%, respectively. At 0.2 s, the maximum cross section flow velocity reached 4.07, 3.84 and 3.67 m/s for the 30°, 40°and 50°models, respectively. In the cycle, the maximum mean flow velocity for the 30°model reached 1.20 m/s. The mean flow rates of the 30°, 40°and 50°models in the J-5 cross section were 349, 316, and 328 ml/min, respectivly. For patient 6, the area proportions of the RRT>1 region were 11.97%, 14.84% and 15.22% for the 30°, 40°and 50°models, respectively.Conclusions:The optimal anastomotic angle of "radial artery-cephalic vein" for end-to-side anastomosis AVF surgery in patients with diabetic nephropathy is 40°.

Objective To evaluate the accuracy of three-dimensional(3D)reconstruction of the gallbladder volume based on computed tomography(CT)images and study the biomechanical changes in gallbladder motility to explore the relationship between gallbladder dynamics and gallstone formation.Methods A method for calculating gallbladder volume based on CT 3D reconstruction of The gallbladder model was proposed and compared with the ellipsoid method.A finite element model of the gallbladder was constructed for fluid dynamics analysis to simulate changes in gallbladder motor function under different angles of convergence between the cystic and common bile ducts and in the presence of gallstones.Results The mean errors of the specific gallbladder model volume and ellipsoid volume of the 50 patients were 7.26％and 25.35％,respectively.During the refilling period,the maximum pressure,deformation,and flow velocity of the pear-shaped gallbladder were significantly higher than those of the gourd-shaped gallbladder.The angle between the gallbladder and common bile duct had little effect on the bile flow pattern,and the maximum bile flow rate was reached at an angle of 120°.The bile flow velocity of the gallbladder with calculus was lower than that of the gallbladder without calculus,and there was a vortex near the calculus.Conclusions Calculating gallbladder volume based on CT 3D reconstruction is more accurate than the ellipsoid method.Compared with a pear-shaped gallbladder,a gourd-shaped gallbladder has lower gallbladder wall contraction,bile flow rate,and poor motor function.The bile flow rate in the gallbladder is slow,which is more likely to lead to the enlargement of gallstones or the formation of new gallstones.

Objective:To establish and validate a gallstones classification method based on deep learning.Methods:A total of 618 gallstones samples were collected from East Hospital Affiliated to Tongji University, and 1 023 high-definition cross-sectional gallstones profile images were captured to construct a cross-sectional gallstones profile image dataset. Based on the traditional eight-category gallstones classification method, a lightweight network model, MobileNet V3, was trained using deep learning and transfer learning methods. The classification performance of MobileNet was evaluated using a confusion matrix with metrics such as accuracy rate, precision rate, F1 score, and recall rate. The MobileNet V3 was improved and further validated using accuracy and loss values.Results:The accuracy rate (94.17%), precision rate (94.03%), F1 score (92.96%) and recall rate (92.99%) of the improved MobileNet V3 model were better than other networks. The improved MobileNet V3 model achieved the highest accuracy rate (94.17%) in gallstones profile classification and was validated by the test set. The confusion matrix showed a weighted average of accuracy rate (92.0%), precision rate (92.6%), and F1 score (92.2%) for each category of gallstones.Conclusions:Based on deep learning, a high-accuracy gallstones classification method is proposed, which provides a new idea for the intelligent identification of gallstones.

Objective To explore the design and clinical application of the bedsheet with postural markers during gastroscopy.Methods A total of 100 outpatients who underwent gastroscopy for the first time in Digestive Endoscopy Center of The First Affiliated Hospital of Naval Medical University from November to December 2021 were selected as research objects by convenience sampling coin method.They were randomly divided into experimental group(n=54)and control group(n=46).The bedsheets with postural markers were used in the experimental group,and ordinary disposable sheets were used in the control group during gastroscopy.One-time success rate of postural placement,time from guidance to completion of postural placement,and patient satisfaction were compared between the 2 groups.Results The time from guidance to completion of postural placement in the experimental group was shorter than that in the control group([7.07±2.44]vs[18.36±5.12]),and the one-time success rate of postural placement(96.30% vs 13.04% )and patient satisfaction([95.76±4.32]vs[68.46±7.59])in the experimental group were significantly higher than those in the control group(P<0.01).Conclusion The clinical application of bedsheets with postural markers during gastroscopy can significantly increase the efficiency of postural placement,shorten the guidance time before operation,maximize the utilization rate of examination beds,and improve patient satisfaction.

Objective:To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice.Methods:A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode.Results:Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD ( P<0.05). Logistic regression analysis showed that visualization of pancreatic duct ( OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation ( OR=0.14), pancreatic atrophy ( OR=0.12) and external drainage ( OR=0.11) were protective factors for pancreatitis. Conclusion:In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.

Objective In order to avoid early restenosis after drug-eluting stent (DES) implantation, the retrievable structure of the NiTi alloy stent and its biomechanical analysis were studied. Methods The geometric models of the retrievable vascular stent and the retrieval system were established. The retrieval part of the stent consisted of four symmetrically distributed tendons, which were designed as circular meshes. The distribution of the maximum strain during stent compression and its uniformity during compression and self-expansion were analyzed, and the simulation experiments of the retrieval process were also performed. Results The maximum strain of the stent was 3.7% and the index of non-uniformity (INU) was 0.62% when the stent was compressed to the minimum size. While the IBU was 1.31% after the self-expansion process completed. The maximum strain was 1.2% when half of the stent was retrieved into the outer sheath. Conclusions The stent could be safely and successfully retrieved into the outer sheath as the strain was within the bearable range of the material and the compression and self-expansion process was relatively uniform. The research findings provide important references for structural design, biomechanical analysis and potential clinical applications of the novel retrievable vascular stent.

To develop a core-shell structure pDNA-CaPi-PLGA nanoparticles (CS-pDNA-CaPi-PLGA-NPs), calcium phosphate-pDNA nano complexes (CaPi-pDNA) were encapsulated inside of PLGA shells. The characteristics of the nanoparticles, including morphology, average particle size, zeta potential, entrapment efficiency, loading efficiency, stability in medium, pDNA protection ability from nuclease degradation, in vitro release, cytotoxicity and cell transfection were investigated and compared with the embedded structured CaPi modified PLGA nanoparticles (embedded-pDNA-CaPi-PLGA-NPs). The results showed that the obtained CS-pDNA-CaPi-PLGA-NPs were spherical in shape with an average particle size of (155 +/- 4.5) nm, zeta potentials of (-0.38 +/- 0.1) mV, entrapment efficiency of (80.56 +/- 2.5)% and loading efficiency of (1.16 +/- 0.04)%. The CS-pDNA-CaPi-PLGA-NPs were stable in the release media and could protect pDNA against nuclease degradation. And they also exhibited sustained release of pDNA in vitro. The highest gene transfection efficiency of the CS-pDNA-CaPi-PLGA-NPs in vitro reached (24.66 +/- 0.46)% (after 72 h transfection), which was significantly higher than that of free pDNA [(0.33 +/- 0.04)%, P < 0.01] and the pDNA-PLGA-NPs [(1.5 +/- 0.07)%, P < 0.01]. Besides, the transfection lasted for longer time than that of embedded-pDNA-CaPi-PLGA-NPs and the cytotoxicity of it was significantly lower than that of PEI (P < 0.01). These results indicate that CS-pDNA-CaPi-PLGA-NPs are a promising non-viral gene vector. Key words: gene delivery system; polylactic-co-glycolic acid; calcium phosphate; nanoparticle

This study was aimed to analyze the medication rules of AIDS fever by Professor Li Fazhi, in order to pro-vide the corresponding medication reference basis for Chinese medicine treatment of AIDS fever. The complex net-work analysis method was used. This study was conducted among AIDS fever patients treated by Professor Li Fazhi from September 2007 to June 2012 in Weishi County, Henan Province. The analysis was made on the etiology and pathogenesis of AIDS fever, syndrome differentiation and treatment as well as medication of senior famous Chinese medicine doctors. The results showed that through a multidimensional query analysis, the core medication in the treatment of AIDS fever included harmonization and heat-clearing herbs such as Bupleurum, Licorice, Scutellaria, as well as qi-supplementing and healthy qi reinforcing herbs such as Codonopsis and Astragalus. The core prescriptions were modified Xiaochaihu Decoction and Buzhong Y iqi Decoction. It was concluded that the treatment rules of AIDS fever by Professor Li Fazhi was to clear heat in combination with supplementing the center and boost qi.

ObjectiveTo analyze the serum creatinine level among apparently healthy primary and secondary school students in Inner Mongolia and explore the distribution of serum creatinine by ethnic,regional,gender and age,and establish the reference interval of serum creatinine in different gender and different age groups of primary and secondary school students.MethodsLargesample clinical epidemiological investigation was applied by two-stage clustering sampling method.Random sample of 2630 primary and secondary school students from 9 to 18-year-old was selected from four district in Inner Mongolia including Hohhot,Wulanchabu,Xilin Gol and Bayan Drow from July 2009 to June 2010.After screening outlier individual,the total of 2614 subjects were enrolled,involving 1288 male and 1326 female subjects,1584 Han and1030 Mongolian.The venous blood was collected and serum was separated.The serum creatinine concentration was measured as soon as possible.Furthermore, creatinine levels of different regions,ethnic,gender and age group were compared by analysis of variance or t-test and that of different group were compared by SNK method.Percentile was used to describe the distribution of serum Cr level of different age groups.The reference interval of serum Cr for primary and secondary school students were established by gender and age (P2.5 -P97.5 ).The curve was smoothed using age-specific percentile ( LMS )curve smoothing method.ResultsThe differences of Cr levels were statistically significant between different regions,ethnic,gender and age groups.The reference intervals of creatinine for 9 - 11,12,13 - 14,15,and 16 - 18 year-old males were 35 - 66,37 - 73,39 - 78,47 - 87 and 49 - 91 μmol/L,respectively.The intervals for 9 - 10,11 - 12,13 - 15,and 16 - 18 year-old females were 32 - 60,34 - 63,38 -73 and 40 -74 μmol/L,respectively.Conclusion The reference intervals of serum creatinine for health primary and secondary school students in the Inner Mongolia is established,which is useful for clinicians,especially pediatricians to judge and assess renal function for 9 to 18 year-old patients.( Chin J Lab Med,2012,35:805-809 )