Automatic classification of medical questions is of great significance in improving the quality and efficiency of online medical services, and belongs to the task of intent recognition. Joint entity recognition and intent recognition perform better than single task models. Currently, most publicly available medical text intent recognition datasets lack entity annotation, and manual annotation of these entities requires a lot of time and manpower. To solve this problem, this paper proposes a medical text classification model, bidirectional encoder representation based on transformer-recurrent convolutional neural network-entity-label-semantics (BRELS), which integrates medical entity label semantics. This model firstly utilizes an adaptive fusion mechanism to absorb prior knowledge of medical entity labels, achieving local feature enhancement. Then in global feature extraction, a lightweight recurrent convolutional neural network (LRCNN) is used to suppress parameter growth while preserving the original semantics of the text. The ablation and comparison experiments are conducted on three public medical text intent recognition datasets to validate the performance of the model. The results show that F1 score reaches 87.34%, 81.71%, and 77.74% on each dataset, respectively. The results show that the BRELS model can effectively identify and understand medical terminology, thereby effectively identifying users' intentions, which can improve the quality and efficiency of online medical services.
Semantics ; Neural Networks, Computer ; Humans ; Natural Language Processing

Objective To investigate the correlations of serum hsa_circ_0002348 and hsa_circ_0001740 levels with the severity of gestational hypertension.Methods A total of 169 patients with gestational hypertension in the hospital from January 2018 to January 2023 were selected as study group,and they were divided into mild preeclampsia group(n=82),severe preeclampsia group(n=47),and eclampsia group(n=40)according to the severity of the disease.Another 169 healthy pregnant women with antenatal examination in the same period were selected as control group.Real-time fluorescent quantitative PCR(qRT-PCR)was used to detect the relative expression levels of serum hsa_circ_0002348 and hsa_circ_0001740.The correlations of serum hsa_circ_0002348 and hsa_circ_0001740 levels with the severity of the disease were analyzed.Receiver operating character-istic(ROC)curve was plotted to analyze the values of serum hsa_circ_0002348 and hsa_circ_0001740 levels in diagnosing eclampsia during pregnancy.Results The systolic and diastolic blood pressures of the control group,mild preeclampsia group,severe preeclampsia group,and eclampsia group were all significantly increased(P＜0.01).The level of serum hsa_circ_0002348 in the eclamp-sia group,severe preeclampsia group,mild preeclampsia group,and control group showed a decreasing trend in sequence,while the level of hsa_circ_0001740 showed an increasing trend in sequence,with significant between-group differences(P＜0.01).The area under the curve(AUC)for diagnosing eclampsia during pregnancy by the combination of serum hsa_circ_0002348 and hsa_circ_0001740 was significantly higher than the AUC for diagnosis by each individual index(Zhsa_circ_0002348:hsa_circ_0002348+hsa_circ_0001740=4.677,P＜0.001;Zhsa_circ_0001740:hsa_circ_0002348+hsa_circ_00017403.579,P＜0.001).Spearman analysis showed that serum hsa_circ_0002348 was positively correla-ted with the severity of the disease(rs=0.751,P＜0.05),while hsa_circ_0001740 was negatively correlated with the severity of the disease(rs=-50.638,P＜0.05).Multivariate Logistic regres-sion analysis showed that systolic blood pressure(OR=2.652),diastolic blood pressure(OR=3.247),hsa_circ_0002348(OR=2.365),and hsa_circ_0001740(OR=0.325)were influen-cing factors of severity of the disease(P＜0.05).Conclusion As the severity of gestational hyper-tension increases,the serum hsa_circ_0002348 level increases significantly,while the hsa_circ_0001740 level decreases significantly.Two indexes are correlated with the severity of gestational hy-pertension.

Objective To investigate the inhibitory effect and mechanism of lentinan on colitis-associated colorectal cancer (CAC) induced by azomethane (AOM)/dextran sulfate sodium salt (DSS) through the IL-6/ STAT3 pathway. Methods C57BL/6 mice were randomly divided into a control group, a model group, a low-dose group (0.865 mg/kg lentinan), a medium-dose group (1.73 mg/kg lentinan), and a high-dose group (3.46 mg/kg lentinan). Except the control group, CAC was induced by AOM/DSS in the other groups, and corresponding drugs were injected intraperitoneally during the modeling process. Body mass, disease activity index (DAI) score, colon length, and tumor number were compared among all groups. Hematoxylin–eosin staining was used to observe the pathological morphology of colon. ELISA was utilized to detect the IL-6, IL-1β, and IL-18 contents in serum. Western blot analysis was conducted to detect the expression levels of IL-6, p-STAT3, and c-Myc in colon tissues. Results The tumor number, DAI score, serum IL-6, IL-1β, and IL-18 contents and the expression levels of IL-6, p-STAT3, and c-Myc in the colon tissue of the model group were higher than those of the control group, while the body mass and colon length were lower than those of the control group (P<0.05). The pathological morphology of colon tissues showed adenocarcinoma formation. After different doses of lentinan intervention, the tumor number, DAI score, serum IL-6, IL-1β, and IL-18 contents and the expression levels of IL-6, p-STAT3, and c-Myc in colon tissues were all lower than those in the model group, while body mass and colon length were higher than those in the model group (P<0.05). The pathological morphology of colon tissues showed adenomas of different grades but no adenocarcinoma was found. Conclusion Lentinan inhibits CAC formation, and its anticancer effect is related to the inhibition of the IL-6/STAT3 pathway.

Objective To explore the correlations between image quality of prospective and retrospective electrocardiogram(ECG)-gated CT coronary angiogram and radiation dose in patients with different heart rates.Methods A total of 135 patients undergoing 256-slice spiral CT coronary angiography were enrolled in the study.Among them,66 cases received prospective ECG-gated scanning(prospective ECG-gated group)and further divided into two subgroups with heart rate≤80 beats/min(prospective ECG-gated+low heart rate subgroup,n=39)and>80 beats/min(prospective ECG-gated+high heart rate subgroup,n=27).The other 69 cases underwent retrospective ECG-gated scanning(retrospective ECG-gated group),including 45 cases with heart rate≤80 beats/min(retrospective ECG-gated+low heart rate subgroup)and 24 with heart rate>80 beats/min(retrospective ECG-gated+high heart rate subgroup).The baseline data,image quality[mean CT value,image noise,signal-to-noise ratio(SNR),subjective image quality score]and radiation dos[CT volume dose index(CTDIvol),dose length product(DLP),effective dose(ED)]were compared among 4 subgroups.The correlations of image quality with heart rate and radiation dose in prospective and retrospective ECG-gated groups were analyzed.Results The heart rates in prospective and retrospective ECG-gated+low heart rate subgroups were lower than those in prospective and retrospective ECG-gated+high heart rate subgroups(P<0.05).When comparing the mean CT value,image noise,SNR and subjective image quality score among 4 subgroups,no statistically significant differences were observed(P>0.05).The CTDIvol,DLP and ED in prospective ECG-gated+low heart rate subgroup were significantly lower than those in the other 3 subgroups(P<0.05),and the indicators in prospective ECG-gated+high heart rate subgroup were lower than those in retrospective ECG-gated group(including low and high heart rate subgroups)(P<0.05).Pearson correlation coefficient analysis revealed that the mean CT value,image noise,SNR,subjective image quality score had no significant correlation with heart rate,CTDIvol,DLP and ED in prospective and retrospective ECG-gated groups(P>0.05).Conclusion The subjective and objective image quality of 256-slice spiral CT coronary angiography is not correlated with radiation dose.Prospective ECG-gated scanning can reduce the radiation dose and ensure the image quality as compared with retrospective ECG-gated scanning.This holds true for eligible patients with high heart rate,and the former can effectively reduce radiation exposure.Therefore,prospective ECG-gated scanning is worthy to be promoted in clinic.

Objective To observe the effect of X-ray-guided placement of intestinal obstruction tube for treating malignant bowel obstruction(MBO)caused by gynecological malignant tumors.Methods Data of 60 patients with intestinal MBO after surgical operations of malignant gynecological tumors,including 30 cases underwent X-ray-guided intestinal obstruction tube placement(group A)and 30 cases underwent traditional nasogastric tube placement(group B),all followed by continuous gastrointestinal decompression were retrospectively analyzed.The remission of MBO symptoms,time of exhaust and defecation,so as diet recovery after treatment were compared between groups.The mean drainage volume within 24 h,tube retention time and treatment-related complications were recorded,and the survival of patients within 1 year after treatment were followed up.Results All 60 patients were successfully catheterized.The time of exhaust and defecation,oral feeding and tube retention time after catheterization in group A were shorter than those in group B(all P＜0.05),while the mean drainage volume within 24 h in group A was larger than that in group B(P＜0.05).No significant difference of relief rate of intestinal obstruction symptoms was found between groups(P=0.472).Minor nasal bleeding occurred in 8 cases,and oropharyngeal discomfort occurred in 4 cases in group A,while each in 5 cases in group B,all relieved without special treatments.No significant difference of treatment-related complication was observed between groups(P=0.361).One year after treatments,28 cases were followed up and 2 cases were lost in both groups,and no significant difference of survival rate was detected between group A(7/28,25.00%)and group B(5/28,17.86%)(P=0.745).Conclusion X-ray-guided placement of intestinal obstruction tube was safe and effective for treating MBO caused by malignant gynecological tumor.

OBJECTIVE: To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity. METHODS: A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation. RESULTS: The patients' incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant ( P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation ( P<0.05) except for mMPTA ( P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°. CONCLUSION LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.
Male ; Female ; Humans ; Arthroplasty, Replacement, Knee/methods* ; Retrospective Studies ; Blood Loss, Surgical ; Osteoarthritis, Knee/surgery* ; Knee Joint/surgery*

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

[摘 要] 目的：探讨长基因间非编码RNA 00519（long intergene non-coding RNA 00519，LINC00519）调控miR-876-3p/高迁移率家族蛋白A1（high mobility group protein A1，HMGA1）轴在胃癌HGC-27细胞的增殖、凋亡、迁移和侵袭中的作用。方法：采用qPCR检测胃癌细胞HGC-27和胃黏膜上皮细胞GES-1中LINC00519的表达水平。将HGC-27细胞按转染处理分为si-NC、si-LINC00519、si-LINC00519+anti-miR-NC和si-LINC00519+anti-miR-876-3p组，采用集落形成实验检测细胞克隆形成能力，流式细胞术检测细胞凋亡和周期分布，Transwell实验检测细胞迁移和侵袭。双荧光素酶报告实验和qPCR验证LINC00519与miR-876-3p、miR-876-3p与HMGA1之间的相互作用。结果：HGC-27细胞中LINC00519表达较GES-1细胞显著升高（P<0.05），转染siRNA后si-LINC00519组HGC-27细胞中LINC00519的表达水平较si-NC组显著降低（t=47.294，P<0.01）。与si-NC组比较，si-LINC00519组HGC-27细胞克隆数、迁移侵袭数、S期细胞比例均显著降低（均P<0.01），凋亡率、G0/G1期细胞比例均显著升高（均P<0.01）。与si-LINC00519+anti-miR-NC组比较，si-LINC00519+anti-miR-876-3p组HGC-27细胞克隆数、迁移侵袭数、S期细胞比例升高（均P<0.01），凋亡率、G0/G1期细胞比例显著降低（均P<0.01）。LINC00519能够靶向负调控miR-876-3p的表达，miR-876-3p靶向负调控HMGA1的表达。结论：敲降LINC00519能够通过调控miR-876-3p/HMGA1轴抑制胃癌HGC-27细胞的增殖、迁移和侵袭，诱导细胞凋亡。

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain and changes in bowel habits. IBS is a multifactorial, stress-sensitive disease. Epigenetic changes include DNA methylation change, histone modification, and differential expressions of microRNA and long non-coding RNA. Explaining the changes in IBS from the perspective of epigenetics could bring new insights for the pathogenesis and treatment of the disease. This article reviewed the progress in research on the epigenetics of IBS.

Objective To investigate the clinical effects and prognostic factors of radical surgery for primary gallbladder cancer (GBC).Methods The retrospective case-control study was conducted.The clinicopathological data of 305 patients with primary GBC who underwent radical Ro resection in the First Affiliated Hospital of Xi'an Jiaotong University from 2013 to 2017 were collected,including 108 males and 197 females,aged from 30 to 88 years,with a median age of 62 years.According to the different tumor staging,patients underwent corresponding operation and adjuvant treatment based on the postoperative indication of chemotherapy.Observation indicators:(1) results of imaging and laboratory examinations;(2) treatment situations:① surgical situations,② postoperative adjuvant treatment;(3) results of postoperative pathological examination;(4) followup;(5) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 5,2018,and death was used as the end point.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.The survival curve and survival rate were respectively drawn and calculated using the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and COX regression model.Results (1) Results of imaging and laboratory examinations:results of imaging examination showed that diagnostic rates of ultrasound,CT and MRI examination were respectively 84.06％ (174/207),85.71％ (168/196) and 63.11％ (65/103).Results of laboratory examination showed that the positive rates of CA19-9,CA125 and carcinoembryonic antigen (CEA) were respectively 55.34％ (145/262),48.06％ (124/258) and 46.15％ (126/273).(2) Treatment situations:① surgical situations:305 patients underwent radical R0 resection for primary GBC,including 145 undergoing liver wedge resection + D2 lymph node dissection,61 undergoing liver wedge resection + D1 lymph node dissection,55 undergoing liver Ⅳ B and Ⅴ segmentectomy + D2 lymph node dissection,11 undergoing liver Ⅳ B and Ⅴ segrnentectomy + D1 lymph node dissection,9 undergoing right hepatectomy + D2 lymph node dissection,5 undergoing liver wedge resection + D2 lymph node dissection + partial colectomy,4 undergoing pancreaticoduodenectomy,3 undergoing simple cholecystectomy in Tis stage,3 undergoing right hepatectomy + D1 lymph node dissection,2 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial colectomy,1 undergoing liver Ⅳ B and Ⅴ segmentectomy + resection and reconstruction of portal vein + D2 lymph node dissection,1 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial resection of the stomach or duodenum,1 undergoing pancreaticoduodenectomy + resection and reconstruction of portal vein,1 undergoing right hepatectomy + pancreaticoduodenectomy,1 undergoing right hepatic lobectomy + partial gastrectomy + D2 lymph node dissection,1 undergoing right hepatic lobectomy + D1 lymph node dissection and 1 undergoing right hepatic trilobectomy + D2 lymph node dissection.Of 94 patients with unsuspected GBC,78 who were diagnosed in the other hospitals received salvage surgery in the authors' center.Twenty-one patients had postoperative surgery-related complications,including 11 with bile leakage,8 with pulmonary infection and 2 with abdominal bleeding.Two patients died in the perioperative period.② Postoperative adjuvant treatment:26 patients underwent postoperative adjuvant chemotherapy.Chemotherapy regimen:gemcitabine + oxaliplatin were used in 12 patients,gemcitabine + tegafur in 7 patients,gemcitabine + cisplatin in 6 patients,oxaliplatin + tegafur in 1 patient.(3) Results of postoperative pathological examination.The postoperative pathological type of 305 patients:257,23,6,5,4,3,3,2,1 and 1 patients were respectively confirmed as pure adenocarcinoma,adenocarcinoma combined with squamous cell carcinoma,adenocarcinoma combined with neuroendocrine carcinoma,mucinous adenocarcinoma,neuroendocrine carcinoma,adenocarcinoma combined with mucinous carcinoma,squamous cell carcinoma,sarcomatoid carcinoma,adenocarcinoma combined with sarcomatoid carcinoma,adenocarcinoma combined with signet-ring cell carcinoma.Degree of tumor differentiation:highdifferentiated,moderate-differentiated and low-differentiated tumors were detected in 37,130 and 121 patients,respectively,17 with unknown differentiated degree.Of 305 patients,16 and 32 patients had respectively vascular invasion and nerve invasion.The number of lymph node dissected of 305 patients was 8±5,with positive lymph node of 0 (range,0-9),including 121 with lymphatic metastasis (26 with jumping lymphatic metastasis).TNM staging of 305 patients:stage 0,Ⅰ,Ⅱ,ⅢA,ⅢB,ⅣA and ⅣB were detected in 7,18,13,137,57,11 and 62 patients,respectively.(4) Follow-up:245 of 305 patients were followed up for 18.0 months (range,6.0-70.0 months).The survival time,1-and 3-year survival rates were respectively 29.5 months (range,0.5-69.9 months),71.6％ and 45.8％.One hundred and twenty-two patients died during the follow-up.(5) Prognostic factors analysis:the results of univariate analysis showed that preoperative level of bilirubin,pathological type,degree of tumor differentiation,liver invasion,vascular invasion,nerve invasion,T staging,N staging and postoperative chemotherapy were factors affecting prognosis of patients with primary GBC (x2 =10.26,3.96,45.89,34.64,12.75,27.05,35.09,39.44,4.40,P＜0.05).The results of multivariate analysis showed that low-differentiated tumor,liver invasion and N2 staging were independent risk factors affecting prognosis of patients with primary GBC [odds ratio (OR)=1.90,1.71,1.46,95％ confidence interval (CI):1.34-2.70,1.15-2.52,1.17-1.82,P＜0.05],and postoperative chemotherapy was a protective factor affecting prognosis of patients with primary GBC (OR=0.35,95％ CI:0.15-0.82,P＜0.05).Conclusions For patients with primary GBC undergoing radical resection,D2 lymph node dissection should be performed routinely.The low-differentiated tumor,liver invasion and N2 staging are independent risk factors affecting prognosis of patients,and postoperative chemotherapy is a protective factor.