Fatigue driving is one of the leading causes of traffic accidents, posing a significant threat to drivers and road safety. Most existing methods focus on studying whole-brain multi-channel electroencephalogram (EEG) signals, which involve a large number of channels, complex data processing, and cumbersome wearable devices. To address this issue, this paper proposes a fatigue detection method based on frontal EEG signals and constructs a fatigue driving detection model using an asymptotic hierarchical fusion network. The model employed a hierarchical fusion strategy, integrating an attention mechanism module into the multi-level convolutional module. By utilizing both cross-attention and self-attention mechanisms, it effectively fused the hierarchical semantic features of power spectral density (PSD) and differential entropy (DE), enhancing the learning of feature dependencies and interactions. Experimental validation was conducted on the public SEED-VIG dataset. The proposed model achieved an accuracy of 89.80% using only four frontal EEG channels. Comparative experiments with existing methods demonstrate that the proposed model achieves high accuracy and superior practicality, providing valuable technical support for fatigue driving monitoring and prevention.
Humans ; Electroencephalography/methods* ; Automobile Driving ; Fatigue/diagnosis* ; Accidents, Traffic/prevention & control* ; Signal Processing, Computer-Assisted ; Neural Networks, Computer ; Algorithms ; Prefrontal Cortex/physiology*

Objective To compare the efficacy of endoscopic parotidectomy through postauricular incision with conventional incision parotidectomy.Methods A total of 60 parotid tumor patients admitted to Zhejiang Cancer Hospital from March 2023 to March 2024 were selected as the study subjects.Thirty patients had the requirement for small scar cosmetic surgery,and the endoscopic parotid tumor resection of the posterior ear were in endoscopic group,and remaining 30 patients underwent traditional open surgery at the same period in open group.Two groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,postoperative complications,nursing satisfaction,and incision satisfaction at one month postoperatively.Results Endoscopic group had significantly lower drainage volume,hospital stay,and postoperative complications than open group,there were significant difference between two groups(P＜0.05).The nursing satisfaction and incision satisfaction in endoscopic group were significantly higher than those in open group(P＜0.05).Conclusion Efficacy of endoscopic parotidectomy through postauricular incision postoperative recovery was faster,the hospitalization time was shorter,and the postoperative complications were less.Perioperative optimization nursing in the endoscopic group improved patient satisfaction,which is worth promoting clinically.

Lupus nephritis(LN)is a common and severe complication of systemic lupus erythematosus(SLE).Approximately 10%of patients with severe LN may progress to end-stage renal disease within 10 years of diagnosis,accompanied by high morbidity and mortality.In the field of treatment,glucocorticoids,antimalarials and other conventional agents have remained the mainstay since the early days,and new therapies emerged slowly until belimumab was approved.In recent years,there has been renewed progress in the research and treatment of SLE and LN,with a series of innovative therapies emerging,including biologics such as anti-B cell-activating factor antibodies,anti-CD20 antibodies,anti-CD40 antibodies,and anti-interferon antibodies,as well as small molecule kinase inhibitors.These developments have shifted treatment strategies towards more individualized and precise approaches.However,despite the expanding array of treatment options,many therapeutic needs remain inadequately met.This paper summarizes recent clinical trials and post-hoc analyses of LN,highlighting advances in promising therapeutic strategies.

Objective To investigate the mechanism by which cancer-associated fibroblast(CAF)in the tumor microenvironment regulate key pathways in prostate cancer stem cells(PCSCs).Methods An in vitro co-culture system of CAF and PCSC was established to observe the effects of CAF on PCSC proliferation and sphere formation.Prostate cancer stem cells were treated with CAF conditioned medium pre-treated with Wnt inhibitor DKK-1 and SDF-1 neutralizing anti-body(MAB310).Western blot was used to detect the expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs.And PCR was used to detect the expression of β-catenin,CXCR4,TCF,and LEF mRNA.TOPflash/FOPflash dual-luciferase reporter assays were conducted to detect the effects of SDF-1 on Wnt/β-catenin signaling activity in PCSCs.Results ELISA results showed that the secretion of Wnt3a and SDF-1 in CAF supernatant was significantly higher than that in WPMY-1 cells(P＜0.05).The A value of PCSCs co-cultured with CAF at a 1∶6 ratio was significantly higher than that of the PCSC-only group(P＜0.0 1),and CAF promoted sphere formation in PCSCs(P＜0.05).Western blot results showed that CAF-CM significantly increased the relative expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs(P＜0.01).Compared to CAF-CM,CAFanti-Wnt-CM significantly reduced the expression of β-catenin,CD133 and CD44(P＜0.01).CAFanti-SDF-1-CM also significantly inhibited the expression of CXCR4,β-catenin,CD133 and CD44(P＜0.01).PCR results showed that CAFanti-SDF-1-CM inhibited the expression of β-catenin,CXCR4 and downstream Wnt signaling effectors TCF and LEF(P＜0.01).Dual-luciferase reporter assay results showed that luciferase activity in the CAFanti-SDF-1-CM group was significantly lower than that in the CAF-CM group(P＜0.05).Conclusion CAF reg-ulates the stemness of PCSCs through the Wnt/β-catenin and SDF-1/CXCR4 pathways.CXCR4 may enhance the mainte-nance of stemness by activating β-catenin.

Objective:To evaluate the clinical efficacy of minimally invasive Chevron-Akin osteotomy (MICA) in the treatment of mild to moderate hallux valgus without addressing the proximal projection.Methods:A retrospective analysis was conducted on 31 patients with unilateral mild to moderate hallux valgus who underwent third-generation MICA surgery at Shanghai Sixth People's Hospital from January 2019 to June 2020. Among these patients, 2 were male and 29 were female, with an average age of 41.13±7.8 years (range: 21-64 years). A total of 12 patients had mild hallux valgus, while 19 patients had moderate hallux valgus. The average body mass index (BMI) was 24.37±1.28 kg/m 2 (range: 22.06-26.13 kg/m 2). Preoperative and postoperative foot X-rays were taken at multiple time points, including 1 day, 1.5 months, 3 months, 12 months, and 24 months after surgery. These X-rays were used to assess the medial eminence width (MEW) of the first metatarsal head, the proximal medial projection width (PMRW) of the first metatarsal, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA). Functional improvements and pain relief were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and the visual analogue scale (VAS). Results:All 31 patients completed an average follow-up period of 25.67±2.35 months (range: 24-31 months). The average operation time was 39.55±7.31 minutes (range: 32-46 minutes). The number of intraoperative fluoroscopy exposures averaged 16.23±2.38 times (range: 13-21 times). At the two-year follow-up, significant improvements were observed in all measured parameters when compared to preoperative values ( P<0.05). The HVA decreased from 35.18°±3.59° before surgery to 10.93°±0.90° after surgery. The IMA was reduced from 11.47°±0.85° to 6.94°±0.65°, and the DMAA decreased from 15.24°±1.13° to 4.31°±0.56°. The MEW decreased from 4.07±0.70 mm to 0.13±0.11 mm. The PMRW, which was measured at one day postoperatively and at the two-year follow-up, decreased from 3.44±0.66 mm to 0.19±0.11 mm. Functional assessments also showed significant improvements ( P<0.05). The AOFAS forefoot score increased from 57.42±3.93 before surgery to 89.52±3.46 at the two-year follow-up. Pain levels, as assessed by the VAS, decreased from 5.68±1.11 preoperatively to 0.77±0.50 postoperatively. At the two-year follow-up, 97% of patients reported excellent satisfaction with the surgical outcome. During the follow-up period, complications included mild numbness around the wound in two cases, metatarsophalangeal joint stiffness in one case, and hallux valgus recurrence in one case, accounting for 3% of the cohort. Conclusion:Third-generation MICA without addressing the proximal projection is an effective procedure for correcting mild to moderate hallux valgus. This technique significantly improves foot function, reduces pain, and leads to high levels of patient satisfaction.

Objective:To evaluate the clinical efficacy of minimally invasive Chevron-Akin osteotomy (MICA) in the treatment of mild to moderate hallux valgus without addressing the proximal projection.Methods:A retrospective analysis was conducted on 31 patients with unilateral mild to moderate hallux valgus who underwent third-generation MICA surgery at Shanghai Sixth People's Hospital from January 2019 to June 2020. Among these patients, 2 were male and 29 were female, with an average age of 41.13±7.8 years (range: 21-64 years). A total of 12 patients had mild hallux valgus, while 19 patients had moderate hallux valgus. The average body mass index (BMI) was 24.37±1.28 kg/m 2 (range: 22.06-26.13 kg/m 2). Preoperative and postoperative foot X-rays were taken at multiple time points, including 1 day, 1.5 months, 3 months, 12 months, and 24 months after surgery. These X-rays were used to assess the medial eminence width (MEW) of the first metatarsal head, the proximal medial projection width (PMRW) of the first metatarsal, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA). Functional improvements and pain relief were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and the visual analogue scale (VAS). Results:All 31 patients completed an average follow-up period of 25.67±2.35 months (range: 24-31 months). The average operation time was 39.55±7.31 minutes (range: 32-46 minutes). The number of intraoperative fluoroscopy exposures averaged 16.23±2.38 times (range: 13-21 times). At the two-year follow-up, significant improvements were observed in all measured parameters when compared to preoperative values ( P<0.05). The HVA decreased from 35.18°±3.59° before surgery to 10.93°±0.90° after surgery. The IMA was reduced from 11.47°±0.85° to 6.94°±0.65°, and the DMAA decreased from 15.24°±1.13° to 4.31°±0.56°. The MEW decreased from 4.07±0.70 mm to 0.13±0.11 mm. The PMRW, which was measured at one day postoperatively and at the two-year follow-up, decreased from 3.44±0.66 mm to 0.19±0.11 mm. Functional assessments also showed significant improvements ( P<0.05). The AOFAS forefoot score increased from 57.42±3.93 before surgery to 89.52±3.46 at the two-year follow-up. Pain levels, as assessed by the VAS, decreased from 5.68±1.11 preoperatively to 0.77±0.50 postoperatively. At the two-year follow-up, 97% of patients reported excellent satisfaction with the surgical outcome. During the follow-up period, complications included mild numbness around the wound in two cases, metatarsophalangeal joint stiffness in one case, and hallux valgus recurrence in one case, accounting for 3% of the cohort. Conclusion:Third-generation MICA without addressing the proximal projection is an effective procedure for correcting mild to moderate hallux valgus. This technique significantly improves foot function, reduces pain, and leads to high levels of patient satisfaction.

Objective To investigate the mechanism by which cancer-associated fibroblast(CAF)in the tumor microenvironment regulate key pathways in prostate cancer stem cells(PCSCs).Methods An in vitro co-culture system of CAF and PCSC was established to observe the effects of CAF on PCSC proliferation and sphere formation.Prostate cancer stem cells were treated with CAF conditioned medium pre-treated with Wnt inhibitor DKK-1 and SDF-1 neutralizing anti-body(MAB310).Western blot was used to detect the expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs.And PCR was used to detect the expression of β-catenin,CXCR4,TCF,and LEF mRNA.TOPflash/FOPflash dual-luciferase reporter assays were conducted to detect the effects of SDF-1 on Wnt/β-catenin signaling activity in PCSCs.Results ELISA results showed that the secretion of Wnt3a and SDF-1 in CAF supernatant was significantly higher than that in WPMY-1 cells(P＜0.05).The A value of PCSCs co-cultured with CAF at a 1∶6 ratio was significantly higher than that of the PCSC-only group(P＜0.0 1),and CAF promoted sphere formation in PCSCs(P＜0.05).Western blot results showed that CAF-CM significantly increased the relative expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs(P＜0.01).Compared to CAF-CM,CAFanti-Wnt-CM significantly reduced the expression of β-catenin,CD133 and CD44(P＜0.01).CAFanti-SDF-1-CM also significantly inhibited the expression of CXCR4,β-catenin,CD133 and CD44(P＜0.01).PCR results showed that CAFanti-SDF-1-CM inhibited the expression of β-catenin,CXCR4 and downstream Wnt signaling effectors TCF and LEF(P＜0.01).Dual-luciferase reporter assay results showed that luciferase activity in the CAFanti-SDF-1-CM group was significantly lower than that in the CAF-CM group(P＜0.05).Conclusion CAF reg-ulates the stemness of PCSCs through the Wnt/β-catenin and SDF-1/CXCR4 pathways.CXCR4 may enhance the mainte-nance of stemness by activating β-catenin.

Objective To compare the efficacy of endoscopic parotidectomy through postauricular incision with conventional incision parotidectomy.Methods A total of 60 parotid tumor patients admitted to Zhejiang Cancer Hospital from March 2023 to March 2024 were selected as the study subjects.Thirty patients had the requirement for small scar cosmetic surgery,and the endoscopic parotid tumor resection of the posterior ear were in endoscopic group,and remaining 30 patients underwent traditional open surgery at the same period in open group.Two groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,postoperative complications,nursing satisfaction,and incision satisfaction at one month postoperatively.Results Endoscopic group had significantly lower drainage volume,hospital stay,and postoperative complications than open group,there were significant difference between two groups(P＜0.05).The nursing satisfaction and incision satisfaction in endoscopic group were significantly higher than those in open group(P＜0.05).Conclusion Efficacy of endoscopic parotidectomy through postauricular incision postoperative recovery was faster,the hospitalization time was shorter,and the postoperative complications were less.Perioperative optimization nursing in the endoscopic group improved patient satisfaction,which is worth promoting clinically.

Objective:To compare the efficacy of conventional open ankle fusion and three dimensional(3D) printed guide plate assisted arthroscopic ankle fusion.Methods:A retrospective cohort study was performed on 256 patients with advanced traumatic ankle arthritis, who were admitted to the Department of Orthopaedics, Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2018 to February 2023 and underwent ankle fusion procedures. The study cohort comprised 119 males and 137 females, with an age of (59.6±9.5) years (range: 37 to 83 years). Among them, 175 cases underwent internal fixation with plates and screws (58 cases through the combined medial and lateral approach, and 117 cases through the simple lateral approach), 48 cases underwent internal fixation with screws through the anterior approach (conventional open group), and 33 cases underwent minimally invasive arthroscopic ankle fusion assisted by 3D printed guide plate (3D printed guide plate arthroscopy group). Propensity score matching was employed to achieve a 1∶1 match(caliper value=0.02) between the baseline characteristics of patients in the 3D printed guide plate arthroscopy group and the conventional open group. Perioperative and follow-up data between the two groups were compared using the t-test, Mann-Whitney U test, Wilcoxon signed rank test, χ2 test or corrected χ2 test as appropriate. Results:Matching was successfully achieved with 20 cases in both the 3D printed guide plate arthroscopy group and the conventional open group, and there were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operation time in the 3D printed guide plate arthroscopy group was significantly longer than that in the conventional open group ((88.9±5.6) minutes vs. (77.9±11.7) minutes; t=-2.392, P=0.022), while the frequency of intraoperative fluoroscopies ((1.7±0.8) times vs. (5.2±1.2) times; t=10.604, P<0.01) and length of hospitalization ((5.5±0.9) days vs. (6.4±1.5) days; t=2.480, P=0.018) were significantly lower in the 3D printed guide plate arthroscopy group compared to the conventional open group. The fusion rate was 95.0% (19/20) in the 3D printed guide plate arthroscopy group and 85.0% (17/20) in the conventional open group, with no statistically significant difference between the two groups ( χ2=0.278, P=0.598). The fusion time was (12.1±2.0) weeks in the conventional open group and (11.1±1.7) weeks in the 3D printed guide plate arthroscopy group, with no statistically significant difference between the two groups ( t=1.607, P=0.116). At the final follow-up, the American Orthopedic Foot and Ankle Society ankle hindfoot scale was (72.6±5.5)points in the 3D printed guide plate arthroscopy group and (70.5±5.8)points in the conventional open group, with no statistically significant difference between the two groups ( t=-1.003, P=0.322). The pain visual analogue score of the 3D printed guide plate arthroscopy group was ( M(IQR)) 1.50 (1.00) points, lower than that of the conventional open group by 3.00 (1.00) points, with statistically significant differences ( Z=-3.937, P<0.01). There was no significant difference in complication rate between the conventional open group and the 3D printed guide plate arthroscopy group (25.0%(5/20) vs. 5.0%(1/20), χ2=1.765， P=0.184). Conclusion:3D printed guide plate assisted arthroscopic ankle fusion exhibited several advantages, including reduced frequency of fluoroscopies, alleviation of postoperative pain, and decreased complications and length of hospitalization.

Osteochondral lesions of the talus (OLT) was defined as lesions involving the articular cartilage and subchondral bone of the talus. The most common cause of OLT is trauma including ankle sprains and fractures, while other causes include non-traumatic factors such as chronic ankle injuries. The diagnosis of OLT is made by combining the patient′s medical history, symptoms and signs, and imaging studies such as X-ray, CT and MRI. Microfracture(MF) is the gold standard of treatment for injuries smaller than 150 mm 2, and while different drill diameters and depths have different effects on outcomes. The overall long-term outcome of MF is of concern. The choice of various restorative or rehabilitative procedures based on the patients’ symptoms, lesion size and staging, as well as the combination with arthrocentesis biotherapy, is a new trend in the treatment of OLT. In addition, for OLT combined with chronic lateral ankle instability(CLAI), ankle impingement or lower limb malalignment, one-stage combined treatment will improve the prognosis of patients. The coming of a new kind of material and a technique, such as hydrogel or organoids, makes a bright future foreseeable.