Objective Based on 25 indicators including immune factors, cell count classification, and smear results of the knee joint fluid, machine learning models were established to distinguish between osteoarthritis (OA) and rheumatoid arthritis (RA). Methods 100 OA and 40 RA patients scheduled for total knee arthroplasty were enrolled respectively. Each patient's knee joint fluid was collected preoperatively. Nucleated cells were counted and classified. The expression levels of immune factors, including tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-8, IL-15, matrix metalloproteinase 3 (MMP3), MMP9, MMP13, rheumatoid factor (RF), serum amyloid A (SAA), C-reactive protein (CRP), and others were measured. Smears and microscopic classification of all the immune factors were performed. Independent influencing factors for OA or RA were identified using univariate binary logistic regression, Lasso regression, and multivariate binary logistic regression. Based on the independent influencing factors, three machine learning models were constructed which are logistic regression, random forest, and support vector machine. Receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to evaluate and compare the models. Results A total of 5 indicators in the knee joint fluid were screened out to distinguish OA and RA, which were IL-1β(odds ratio(OR)=10.512, 95× confidence interval (95×CI) was 1.048-105.42, P=0.045), IL-6 (OR=1.007, 95×CI was 1.001-1.014, P=0.022), MMP9 (OR=3.202, 95×CI was 1.235-8.305, P=0.017), MMP13 (OR=1.002, 95× CI was 1-1.004, P=0.049), and RF (OR=1.091, 95×CI was 1.01-1.179, P=0.026). According to the results of ROC, calibration curve and DCA, the accuracy (0.979), sensitivity (0.98) and area under the curve (AUC, 0.996, 95×CI was 0.991-1) of the random forest model were the highest. It has good validity and feasibility, and its distinguishing ability is better than the other two models. Conclusion The machine learning model based on immune factors in the knee joint fluid holds significant value in distinguishing OA and RA. It provides an important reference for the clinical early differential diagnosis, prevention and treatment of OA and RA.
Humans ; Arthritis, Rheumatoid/metabolism* ; Machine Learning ; Male ; Female ; Middle Aged ; Aged ; Synovial Fluid/immunology* ; Osteoarthritis, Knee/metabolism* ; Knee Joint/metabolism* ; ROC Curve ; Diagnosis, Differential

To address the problem of large reconstruction errors in 3D pulse signals caused by excessively small out-of-plane displacement of the contact membrane in the existing traditional Chinese medicine fingertip tactile binocular vision detection technology, this study proposes a 3D pulse image detection method based on subtle motion magnification technology and explores its application in pulse pattern recognition. Firstly, a 3D pulse image detection system based on binocular vision to obtain pulse image signals is developed as experimental data. Then, the phase motion video magnification algorithm is used to amplify the original signals, and the amplified signals are reconstructed in three dimensions to obtain 3D pulse signals. On this basis, nine features are extracted from the 3D pulse signals and features selection is performed using a two-sample Kolmogorov-Smirnov test. Finally, machine learning algorithms such as decision trees and random forests are used to identify the five types of pulse conditions: deep pulse, intermittent pulse, flooding pulse, slippery pulse, and rapid pulse. The experimental results show that compared to the methods without subtle motion magnification technology, the proposed method significantly improves waveform clarity, amplitude stability, and periodic regularity. Meanwhile, the average accuracy in pulse pattern recognition reaches 96.29%±0.26%.
Algorithms ; Imaging, Three-Dimensional/methods* ; Pattern Recognition, Automated ; Medicine, Chinese Traditional ; Motion ; Humans ; Pulse ; Signal Processing, Computer-Assisted ; Machine Learning

Increasing evidence has underscored the significance of post-stroke alterations along gut-brain axis, while its role in pathogenesis and treatment of ischemic stroke (IS) remains largely unexplored. This study aimed to elucidate the therapeutic effects and action targets of Panax notoginseng saponins (PNS) on IS and explore a novel pathogenesis and treatment strategy of IS via profiling the microbial community and metabolic characteristics along gut-brain axis. Our findings revealed for the first time that the therapeutic effect of PNS on IS was microbiota-dependent. Ischemia/reperfusion (I/R) modeling significantly down-regulated Lactobacilli in rats, and PNS markedly recovered Lactobacilli, particularly Lactobacillus reuteri (L.Reu). Metabolomics showed a significant reduction in serum histidine (HIS) in clinical obsolete IS patients and rehabilitation period I/R rats. Meanwhile, the L.Reu colonization in I/R rats exhibited significant neuroprotective activity and greatly increased HIS in serum, gut microbiota, and brain. Moreover, exogenous HIS demonstrated indirect neuroprotective effects through metabolizing to histamine. Notably, vagus nerve severance in I/R rats was performed to investigate HIS's neuroprotective mechanism. The results innovatively revealed that PNS could promote HIS synthesis in gut by enhancing L.Reu proportion, thereby increasing intracerebral HIS through peripheral pathway. Consequently, our data provided novel insights into HIS metabolism mediated by L.Reu in the pathogenesis and treatment of IS.

Objective:To investigate the related factors affecting the survival of adult patients with newly diagnosed chronic myeloid leukemia in the chronic phase (CML-CP) treated with tyrosine kinase inhibitor (TKI) and the prognostic predictive effect of the nomogram constructed according to them.Methods:A retrospective cohort study was conducted. Clinical general information and laboratory index data of 243 newly diagnosed adult CML-CP patients treated with TKI in the First Hospital of Lanzhou University from December 2008 to June 2023 were collected, and they were divided into a training set (194 patients) and a validation set (49 patients) by complete randomization in the ratio of 8∶2. In the training set, variables affecting poor overall survival (OS) of patients were analyzed using univariate and multivariate Cox proportional hazards models by R4.3.2 software to obtain the independent influences of poor OS, on the basis of which the Cox regression model was constructed and the nomogram predicting the OS rate at 8 and 10 years was plotted. Kaplan-Meier method was applied to analyze the OS in all 243 patients and patients stratified by the screened independent influencing factors for poor OS, and log-rank test was used for comparison between the groups. In the training and validation sets, receiver operating characteristic (ROC) curve was used to analyze the effect of the nomogram on predicting 8- and 10-year OS rates of patients with actual survival as the gold standard; calibration curve was used to assess the accuracy of predictions of the nomogram; decision curve analysis (DCA) was used to assess the clinical utility of the nomogram.Results:The median age of 243 CML-CP patients [ M ( Q1, Q3)] was 46 (35, 58) years old, 150 cases (61.7%) were male and 9 cases (38.3%) were female, 119 cases (49.0%) had comorbidities, and the efficacy of 82 cases (33.7%) reached molecular response (MR) 5.0. Differences in patient compositions for age and gender, levels of major indicators for peripheral blood and bone marrow, spleen size, comorbidities, short-term efficacy, Sokal score, and long-term survival score of European Treatment and Outcomes Study between the training and validation sets were not statistically significant (all P > 0.05). Multivariate Cox regression analysis showed that patients with elevated age ( HR = 1.04, 95% CI: 1.01-1.08, P = 0.041), comorbidities (with vs. without, HR = 3.48, 95% CI: 1.23-9.86, P = 0.019), and those who did not achieve MR5.0 (achieved vs. unachieved, HR = 0.13, 95% CI: 0.02-0.97, P = 0.046) were independent risk factors for poor OS in TKI-treated newly diagnosed adult CML-CP patients. By the last follow-up (December 2023), the median follow-up was 72 months, with the range of 6-180 months. Kaplan-Meier method analysis showed that the 8- and 10-year OS rates of 243 patients were 83.7% and 81.6%, respectively; patients with age ≥46 years compared to <46 years, with comorbidities compared to without comorbidities, and who did not achieve MR5.0 in terms of efficacy compared to who achieved MR5.0, the OS was poorer, and the differences were statistically significant (all P < 0.01). The nomogram of 8- and 10-year OS rates in TKI-treated newly diagnosed adult CML-CP patients was constructed based on the screened independent influencing factors of poor OS. The area under the ROC curve was 0.910 and 0.851 in the training set and 0.778 and 0.764 in the validation set for the predicted 8- and 10-year OS rates based on the nomogram, respectively, and the calibration curve showed that the predicted 8- and 10-year OS rates based on the nomogram were in high agreement with the actual ones in the training and validation sets; the DCA showed that the nomogram within a certain prediction threshold could benefit the clinical decision-making in both the training and validation sets. Conclusions:Having comorbidities, not reaching MR5.0 in efficacy and old age are independent risk factors for poor survival of TKI-treated adult patients with newly diagnosed CML-CP, and the nomogram constructed based on these 3 factors has a good predictive ability for the survival of such patients.

Objective:To explore the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with resistance training on stroke related muscle atrophy(SRS) based on propensity score matching (PSM) method.Methods:A retrospective analysis was conducted on the clinical data of 150 cases of SRS patients in our hospital from September 2022 to September 2024. The patients were divided into an observation group of 78 cases and a control group of 72 cases according to the treatment method. Using PSM method to balance the confounding factors before treatment in a 1:1 ratio, 40 cases were successfully matched in each group. The control group received resistance training, while the observation group received TEAS treatment in addition to the control group. Both groups received continuous treatment for 12 weeks. Before and after treatment, the MedTrack Length isokinetic muscle strength testing system was used to measure the patients' knee extension and flexion axis muscle strength values, and the body composition analyzer was used to measure the patients' muscle weight and muscle index. The Berg Balance Scale (BBS), Fugl Meyer Motor Function Scale (FMA), and Simplified Upper Limb Function Scale (STEF) were used to evaluate limb motor function. ELISA method was used to detect the levels of muscle growth inhibitor (MSTN), growth differentiation factor 15 (GDF-15), and insulin-like growth factor-1 (IGF-1). The occurrence of adverse reactions during the treatment of two groups and the clinical efficacy was evaluated.Results:The total effective rate of the observation group was 92.50% (37/40), while that of the control group was 75.00% (30/40), with statistical significance ( χ2=4.50, P=0.034). After treatment, the observation group showed higher levels of knee extension [(78.25 ± 6.11) Nm vs. (74.02 ±6.02) Nm, t=3.11], flexion axis muscle strength [(32.84 ± 4.11) Nm vs. (29.35 ± 3.94) Nm, t=3.88], muscle weight [(41.42 ± 3.06) kg vs. (38.29 ± 3.12) kg, t=4.53], and muscle index [(7.11±1.17) kg/m 2vs. (6.56 ± 1.05) kg/m 2, t=2.21] compared to the control group ( P<0.01 or P<0.05). After treatment, the BBS, FMA and STEF scores in the observation group were higher than those in the control group ( t=4.57, 3.23,2.73, respectively, P<0.01), and the levels of serum MSTN [(46.34 ± 5.98) μg/L vs. (51.44 ± 6.04) μg/L, t=3.79] and GDF-15 [(67.44±7.21) μg/L vs. (72.28 ± 8.04) μg/L, t=2.83] in the observation group were lower than those in the control group after treatment ( P<0.01); the level of IGF-1 [(37.92 ±5.66) ng/L vs. (31.09 ± 4.22) ng/L, t=6.11] was higher than that of the control group ( P<0.01). During the treatment period, the incidence of adverse reactions in the observation group was 10.00% (4/40), while in the control group it was 7.50% (3/40), without statistical significance ( χ2=0.16, P=0.692). Conclusion:TEAS combined with resistance training can improve muscle strength and weight in SRS patients, improve limb motor function, reduce serum markers related to muscle attenuation, and have good treatment safety.

Objective To explore the effect observation of four-dimension innovative service concept applied to hospital logistics management.Methods Retrospective analysis of the survey results of 500 hospitalized patients,42 hospital staff,187 public facilities/medical instruments and equipment before and after the application of the four-dimension innovative service con-cept(March-June 2022)and after the application(March-June 2023).The satisfaction of patients and employees on logistics work and the difference of repair rate and complaint rate before and after application were compared.Results After the applica-tion,the satisfaction of patients and staff on logistics work were significantly higher than before the application(P＜0.05),and the repair rate of logistics after the application(10.70％)was significantly lower than before the application(18.18％)(P＜0.05),and the complaint rate of logistics(5.00％)was also significantly lower than before the application(8.20％)(P＜0.05).Conclusion The application of four-dimensional innovative service concept in hospital logistics management can effec-tively enhance the satisfaction of patients and staff on logistics work,and reduce the logistics repair rate and complaint rate,and it can be popularized in various hospitals.

Objective:To investigate the long-term efficacy of self-designed posterior atlas polyaxial screw-plate in the treatment of unstable atlas fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 20 patients with unstable atlas fracture who were admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2011 to April 2013, including 14 males and 6 females, aged 23-60 years [(42.7±8.6)years]. All the patients were treated with internal fixation using self-designed posterior atlas polyaxial screw-plate. The operation time and intraoperative bleeding volume were recorded. The fracture reduction was evaluated by CT scan at 3 days after surgery. The bone healing was observed by X-ray (anterior-posterior and lateral views of the cervical spine) and CT scan at 9 months after surgery. The delayed spinal cord injuries were evaluated by Frankel grade at 1 and 2 years after surgery and at the last follow-up. The Visual Analogue Scale (VAS) before surgery, at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. The axial rotation, flexion and extension range of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 121-148 months [(135.0±6.8)months]. The operation duration was 68-122 minutes [(86.0±14.1)minutes], with the intraoperative blood loss of 90-400 ml [(120.0±67.9)ml]. The CT scan of the cervical spine at 3 days after surgery showed all satisfactory fracture reduction. Satisfactory bone reunion was observed at 9 months after surgery. All patients were scaled as Frankel grade E at 1 year, 2 years and at the last follow-up after surgery, with no delayed spinal cord injuries observed. The VAS scores of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were 2.0(1.3, 3.0)points, 1.0(1.0, 1.8)points, 1.0(0.3, 1.0)points and 1.0(0.3, 1.0)points, which were significantly lower than that before surgery [7.0(6.0, 7.8)points] ( P<0.05), with significantly lower scores at 1-, 2-year after surgeny and at the last follow-up than at 3 months after surgery ( P<0.05). There were no significant differences among the other time points ( P>0.05). The axial rotation ranges of the cervical spine were (103.0±8.3)°, (128.3± 11.4)° and (129.8±13.6)° at 1 year, 2 years after surgery and at the last follow-up respectively, which were significantly higher than that at 3 months after surgery [(85.3±7.0)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference at the last follow-up compared with that at 2 years after surgery ( P>0.05). The flexion and extension range of the cervical spine at 1 year, 2 years after surgery and at the last follow-up were (65.5±4.8)°, (78.3±6.5)° and (79.3±6.9)° respectively, which were significantly higher than that at 3 months after surgery [(54.3±4.4)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference between the last follow-up and 2 years after surgery ( P>0.05). No intraoperative injuries such as arteriovenous injury were observed. No incision infection or dehiscence occurred after surgery, with no complications caused by long-term bed rest such as lung or urinary tract infection, pressure sore formation or deep vein thrombosis occurred. No loosening or breakage of the screw and atlas plate was observed at the long-term follow-up. One patient had mild cervical pain, snap during rotation, and limited range of motion at the last follow-up. Conclusion:Self-designed posterior atlas polyaxial screw-plate has merits including small surgical wounds, satisfactory reduction, solid fixation, obvious pain relief, effective preservation of the previous cervical motion, few complications, and satisfactory long-term efficacy in the treatment of unstable atlas fracture.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the clinical application effect of bypass vein bridging in repairing high-voltage electric burn wounds on the head with free anterolateral thigh flaps.Methods:This study was a retrospective observational study. From May 2017 to December 2022, 8 patients with high-voltage electric burns on the head who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 6 males and 2 females, aged 33 to 73 years. All patients had skull exposure, including 3 cases of large skull defect, 1 case of left eye necrosis, and 3 cases of cerebral hemorrhage. After debridement, the head wound area was from 13 cm×7 cm to 21 cm×15 cm, and the free anterolateral thigh flap with the area of 14 cm×8 cm to 22 cm×16 cm was cut for repair. The main descending branch of the lateral circumflex femoral artery carried by the flap was anastomosed end-to-end with the superficial temporal artery in the recipient area. One accompanying vein of the anastomotic artery of the flap was end-to-end anastomosed with the branch of the external jugular vein via great saphenous vein bridging, and the other accompanying vein was end-to-end anastomosed with the superficial temporal vein in the recipient area. The donor site wounds were directly sutured or closed with medium-thickness skin grafts from inner thigh. The blood supply and survival of the flap, and the wound healing on the head were observed after operation. The blood flow and lumen filling of the transplanted vein were observed and recorded by using color ultrasound diagnostic system within 2 weeks after operation. The wound repair method and wound healing of the flap donor site were recorded and observed. Patients were followed up to observe the appearance of the flaps and the flap donor sites, the muscle strength of the lower limbs where the flap donor site was located, and whether the patient could complete standing, walking, and squatting using the lower limbs where the flap donor site was located.Results:The flaps of 8 patients survived after operation, and no arterial or venous crisis occurred. The wounds of 5 patients on the head healed after operation, and the wounds of 3 patients on the head healed after second debridement 21 to 35 days after operation due to exudates under the flap 2 weeks after operation. Within 2 weeks after operation, the grafted vein continued to be unobstructed. After the ultrasound probe was pressurized, the grafted vein could be deflated, and the blood vessels were rapidly filled after the probe was released. The wounds of flap donor sites of 3 patients were directly sutured and healed 2 weeks after operation. The wounds of flap donor sites of 5 patients were closed with medium-thickness skin grafts from inner thigh, and all the skin grafts survived 12 days after operation. During follow-up of 6 to 12 months, the head flaps of all patients were slightly bloated without hair growth. Mild linear or patchy scar hyperplasia was left in the donor site. The muscle strength of the lower limbs where the flap donor site was located was normal and did not decrease. The patients could stand, walk, and squat with the lower limbs where the flap donor site was located.Conclusions:When using the free anterolateral thigh flap to repair high-voltage electric burn wounds of various areas and depths on the head, bypass vein bridging can reduce the occurrence of postoperative flap vein crisis and improve the quality of postoperative wound healing without affecting the function of the lower limbs where the flap donor site is located.

Objective:To investigate the clinical efficacy of electrical stimulation, biofeedback, and radiofrequency therapy in combination for the treatment of pelvic floor dysfunction.Methods:A total of 144 patients with pelvic floor dysfunction who received treatment in Lianyungang Maternal and Child Health Hospital from June 2020 to June 2022 were included in this prospective randomized controlled study. They were randomly assigned to undergo electrical stimulation combined with biofeedback (electrical stimulation group, n = 48), treatment with a novel radiofrequency technique (radiofrequency therapy group, n = 48), or electrical stimulation, biofeedback, and treatment with a novel radiofrequency technique (combined group, n = 48). Pelvic floor dysfunction, stress urinary incontinence, and pelvic floor myofascial pain were compared among the three groups. Pelvic organ prolapse quantification was compared among the three groups before and after treatment. Quality of life was evaluated. Results:The effective rates of treatment against pelvic floor dysfunction, stress urinary incontinence, and pelvic floor myofascial pain in the combined group were 95.83% (46/48), 97.92% (47/48), and 93.75% (45/48), respectively, which were significantly higher than 79.17% (38/48), 79.17% (38/48), 77.08% (37/48) in the radiofrequency group, and 75.00% (36/48), 77.08% (37/48), 72.92% (35/48) in the electrical stimulation group ( χ2 = 8.40, 9.77, 7.66, all P < 0.05). After treatment, the severity of pelvic organ prolapse in the combined group was significantly milder than that in the novel radiofrequency technique group and electrical stimulation group (both P < 0.05). The scores of the pelvic floor dysfunction questionnaire and urinary incontinence questionnaire in the combined group were significantly lower than those in the radiofrequency therapy group and the electrical stimulation group (both P < 0.05). Conclusion:Electrical stimulation, biofeedback, and radiofrequency therapy in combination can greatly strengthen the muscle strength of the pelvic floor, relieve urinary incontinence, reduce pelvic floor myofascial pain, and improve the quality of life of patients with pelvic floor dysfunction.