OBJECTIVE: To propose a machine learning-based method for predicting the trajectories during manual acupuncture manipulation (MAM), aiming to improve the precision and consistency of acupuncture practitioner' operation and provide the real-time suggestions on MAM error correction. METHODS: Computer vision technology was used to analyze the hand micromotion when holding needle during acupuncture, and provide a three-dimensional coordinate description method of the index finger joints of the holding hand. Focusing on the 4 typical motions of MAM, a machine learning-based MAM trajectory predictive model was designed. By integrating the changes of phalangeal joint angle and hand skeletal information of acupuncture practitioner, the motion trajectory of the index finger joint was predicted accurately. Besides, the roles of machine learning-based MAM trajectory predictive model in the skill transmission of acupuncture manipulation were verified by stratified randomized controlled trial. RESULTS: The performance of MAM trajectory predictive model, based on the long short-term memory network (LSTM), obtained the highest stability and precision, up to 98%. The learning effect was improved when the model applied to the skill transmission of acupuncture manipulation. CONCLUSION The machine learning-based MAM predictive model provides acupuncture practitioner with precise action prediction and feedback. It is valuable and significant for the inheritance and error correction of manual operation of acupuncture.
Humans ; Acupuncture Therapy/instrumentation* ; Machine Learning ; Adult ; Male ; Female

To address the limitations of traditional minimally invasive thermal ablation technology such as poor conformability, carbonization and electromagnetic radiation, this paper proposes a steam thermal ablation technology that uses saturated steam internal energy to replace the traditional electromagnetic radiation energy. Through the steam thermal ablation system and the steam thermal ablation needle designed based on simulation, the ex vivo pig liver experiments were carried out. The results have the characteristics of the maximum ablation axis ratio (short diameter / long diameter) and non-carbonization with the same type of thermal ablation technology. Based on the near-infrared light, in this paper the curative effect of the reduced scattering coefficient of the steam thermal ablation results was evaluated. The reduced scattering coefficients of the coagulation area all exceeded 16, reaching the completely damaged state, which verified that the steam thermal ablation can effectively inactivate the tumor cells.
Steam ; Animals ; Swine ; Liver Neoplasms/surgery* ; Ablation Techniques/methods* ; Liver/surgery* ; Equipment Design

The minimally invasive thermal ablation technology differs from traditional surgical operations, which requires auxiliary equipment to evaluate ablation results. However, the ultrasound and CT currently used in clinical practice have shortcomings such as artifacts and radiation. Therefore, this paper proposes a design for a minimally invasive thermal ablation evaluation system based on the principle of electrical impedance tomography technology to monitor the ablation range. At the same time, the innovative introduction of a programmable gain feedforward signal as the parameter signal of the multiplier demodulator in the electrical impedance tomography system design can effectively solve the problem of weak signals being submerged in noise and improve imaging accuracy. The system controls the amplitude of the excitation current signal and the acquisition / processing of boundary voltages via an STM32, uploads the collected data to an upper computer, and reconstructs the conductivity distribution using the Newton-Raphson algorithm to map the size of the ablation area. Experimental results show that the system can effectively reflect the size of the microwave ablation area. Under the same minimally invasive ablation parameters, the average imaging errors are 0.6 mm for the long diameter, 0.8 mm for the short diameter, and 1.75% for the axial ratio (long diameter / short diameter), demonstrating high consistency. This verifies the technical potential of electrical impedance tomography in minimally invasive thermal ablation.
Electric Impedance ; Tomography/instrumentation* ; Equipment Design

With the popularization of 5G communication technology and the continuous upgrade of robot-assisted surgery system,telesurgery has developed rapidly.However,there are few of reports about this technique in single-port laparoscopic gynecological surgery.On April 19,2024,the surgeons at the Second Affiliated Hospital of Naval Medical University in Shanghai successfully implemented robot-assisted single-port laparoscopic bilateral adnexectomy for a patient who was admitted to the Naval Hospital of the Eastern Theater Command in Zhoushan,Zhejiang Province through 5G communication technology.The operation time was 90 min,intraoperative bleeding was 20 ml,and no intraoperative complications occurred.There were no adverse events caused by robots such as robot system failure and instrument failure,or adverse events caused by remote communication such as network interruption and network attack.Intraoperative user datagram protocol(UDP)real-time monitoring data showed an average delay of 108 ms(range,105-111 ms)and a packet loss rate of 0.04%.The surgeons had a slight sense of delay when the operation amplitude was too large.There was no obvious stalling which affected the process of the operation.The patient was able to move around on the first day after surgery,and the catheter was removed.No postoperative complications occurred.The patient was discharged from the hospital on the second day after surgery.Postoperative pathological results revealed left fallopian tube ovarian serous cystadenofibroma,fallopian tubal tissue;right fallopian tube ovarian,sent for examination as ovarian and fallopian tube tissue.There were no complaints of discomfort during reexamination one month after surgery,and the umbilical incision healed well.This case is an attempt of telesurgery in the field of gynecology,and provides experiences for the further development of this technique.

Objective To evaluate the clinical application of CT-guided coaxial needle biopsy in pancreatic puncture-cutting biopsy via adipose tissue space.Methods The clinical data of 30 patients,who received CT-guided pancreatic coaxial needle biopsy via adipose tissue space at the Pingdu Hospital Area of Affiliated Hospital of Qingdao University of China from June 2021 to April 2024,were retrospectively analyzed.The patients included 20 males and 10 females with a mean age of(65.1±8.7)years.The lesions were located in the pancreatic head(n=7),pancreatic neck(n=4),pancreatic body(n=7),pancreatic tail(n=10)and uncinate process(n=2).Under CT guidance,a 17 G co-axial guiding needle was inserted to establish a puncture pass through adipose tissue space,then an 18 G biopsy needle was used to make tissue sampling.A total of 32 procedures of pancreatic puncture-cutting biopsy were performed,two of these patients received two times of biopsy.After sampling,a self-made blocking agent(a mixed liquid of gelatin sponge particles and snake venom hemagglutinin),was used to occlude the puncture channel so as to prevent complications such as bleeding,pancreatic leakage,needle tract implantation metastasis,etc.Results A total of 32 procedures of pancreatic puncture-cutting biopsy with coaxial guiding needle via adipose tissue space were performed,including two patients who received two times of biopsy.The success rate of puncturing was 100％(32/32),the success rate of sampling was 93.8％(30/32),and the accuracy of sampling was 93.8％(30/32).No serious puncture-related complications occurred in all patients.Conclusion CT-guided pancreatic coaxial needle biopsy via adipose tissue space is clinically safe,accurate in sampling and minimally-invasive.This interventional diagnostic technique is worth applying in clinical practice.

Objective To explore the effect of SGLT2 inhibitor(SGLT2i)Dagaglipzin(Dap)on mitochondrial autophagy in cardiomyocytes in diabetic cardiomyopathy(DCM)by regulating mitochondrial membrane transporter TOM20.Methods H9C2 cardiomyocytes cultured in vitro were divided into normal control(Con)group,HG+PA group,knockout TOM20(HG+PA+siTOM20)group,knockout control(HG+PA+siNC)group,Dap intervention(HG+PA+Dap)group,and solvent control(HG+PA+DMSO)group.The expression of TOM20 was predicted by RNA-seq second-generation sequencing in HG+PA group.The expression of TOM20 and mitochondrial autophagy related proteins was detected by Western blot,the mitochondrial membrane potential was measured by immunofluorescence staining,and the mitochondrial autophagy level was evaluated by transmission electron microscopy.Results Compared with Con group,protein expressions of TOM20 and P62 were increased(P<0.05),while protein expressions of ULK1,Parkin,Beclin1 and LC3-B were decreased(P<0.05),mitochondrial membrane potential was destroyed,the number of mitochondrial autophagosomes was reduced,and autophagy activity was inhibited in HG+PA group.Compared with HG+PA+siNC group and HG+PA+DMSO group,the protein expressions of TOM20 and P62 were decreased(P<0.05),while the protein expressions of ULK1,Parkin,Beclin1 and LC3-B were increased(P<0.05),the damage of mitochondrial membrane potential decreased,the number of mitochondrial autophagosomes increased,and the inhibition of autophagy activity reversed in HG+PA+siTOM20 and HG+PA+DAPA groups.Conclusions SGLT2 inhibitors appear to partially restore mitochondrial function in diabetic cardiomyopathy by suppressing TOM20 expression,potentially through activation of mitochondrial autophagy.

Objective To develop a postoperative precision nursing program for children with obstructive sleep apnea-hypopnea syndrome(OSAHS),so as to provide references for the improvement of nursing quality for children with OSAHS.Methods Literature in precision nursing for children with OSAHS was systematically reviewed and summarised based on precision nursing theory and a postoperative precision nursing program was drafted.Using the Delphi's Method,two rounds of expert consultation were conducted and the postoperative precision nursing program for children with OSAHS was revised and finalised.Results The response rates of the two rounds of expert consultation were 100.00%with the expert authority coefficient of 0.875.The Kendall coefficient of concordance(W)of levels 1,2 and 3 indices in the second round of expert consultation were 0.289,0.203,0.187,respectively(all P<0.01).The importance score of each inclicator ranged from 4.50～4.94.The coefficient of variations for the three-level indices ranged from 0.05 to 0.21.The finalised program composed 8 level-1 indices(postoperative position assessment,intervention,prevention and care of bleeding,maintaining postoperative airway patency,postoperative nausea and vomiting care,postoperative pain assessment and care,dietary care,complication prevention and care,discharge guidance),16 level-2 indices,and 22 level-3 indices.Conclusion The postoperative precision nursing program for the children with OSAHS is scientific,innovative and applicable.It provides clinical references for nursing of the children with OSAHS.

Objective To explore the effect of SGLT2 inhibitor(SGLT2i)Dagaglipzin(Dap)on mitochondrial autophagy in cardiomyocytes in diabetic cardiomyopathy(DCM)by regulating mitochondrial membrane transporter TOM20.Methods H9C2 cardiomyocytes cultured in vitro were divided into normal control(Con)group,HG+PA group,knockout TOM20(HG+PA+siTOM20)group,knockout control(HG+PA+siNC)group,Dap intervention(HG+PA+Dap)group,and solvent control(HG+PA+DMSO)group.The expression of TOM20 was predicted by RNA-seq second-generation sequencing in HG+PA group.The expression of TOM20 and mitochondrial autophagy related proteins was detected by Western blot,the mitochondrial membrane potential was measured by immunofluorescence staining,and the mitochondrial autophagy level was evaluated by transmission electron microscopy.Results Compared with Con group,protein expressions of TOM20 and P62 were increased(P<0.05),while protein expressions of ULK1,Parkin,Beclin1 and LC3-B were decreased(P<0.05),mitochondrial membrane potential was destroyed,the number of mitochondrial autophagosomes was reduced,and autophagy activity was inhibited in HG+PA group.Compared with HG+PA+siNC group and HG+PA+DMSO group,the protein expressions of TOM20 and P62 were decreased(P<0.05),while the protein expressions of ULK1,Parkin,Beclin1 and LC3-B were increased(P<0.05),the damage of mitochondrial membrane potential decreased,the number of mitochondrial autophagosomes increased,and the inhibition of autophagy activity reversed in HG+PA+siTOM20 and HG+PA+DAPA groups.Conclusions SGLT2 inhibitors appear to partially restore mitochondrial function in diabetic cardiomyopathy by suppressing TOM20 expression,potentially through activation of mitochondrial autophagy.

Objective To develop a postoperative precision nursing program for children with obstructive sleep apnea-hypopnea syndrome(OSAHS),so as to provide references for the improvement of nursing quality for children with OSAHS.Methods Literature in precision nursing for children with OSAHS was systematically reviewed and summarised based on precision nursing theory and a postoperative precision nursing program was drafted.Using the Delphi's Method,two rounds of expert consultation were conducted and the postoperative precision nursing program for children with OSAHS was revised and finalised.Results The response rates of the two rounds of expert consultation were 100.00%with the expert authority coefficient of 0.875.The Kendall coefficient of concordance(W)of levels 1,2 and 3 indices in the second round of expert consultation were 0.289,0.203,0.187,respectively(all P<0.01).The importance score of each inclicator ranged from 4.50～4.94.The coefficient of variations for the three-level indices ranged from 0.05 to 0.21.The finalised program composed 8 level-1 indices(postoperative position assessment,intervention,prevention and care of bleeding,maintaining postoperative airway patency,postoperative nausea and vomiting care,postoperative pain assessment and care,dietary care,complication prevention and care,discharge guidance),16 level-2 indices,and 22 level-3 indices.Conclusion The postoperative precision nursing program for the children with OSAHS is scientific,innovative and applicable.It provides clinical references for nursing of the children with OSAHS.

Objective To evaluate and compare the maturity of autografts and allografts as well as the postoperative clinical outcomes 10 years after anterior cruciate ligament reconstruction(ACLR).Methods A retrospective analysis was conducted on 64 patients who underwent anterior cruciate liga-ment reconstruction,with an average follow-up period of about 10 years.Autografts were used in 36 cases(56.2%),and allografts in 28 cases(43.8%).Both groups were recorded the knee Lysholm scores,IKDC subjective scores,and stability tests results(KT-1000 side-to-side difference and Lach-man test).Moreover,graft maturity was assessed using the knee magnetic resonance imaging(MRI),and the Signal-to-Noise Quotient(SNQ)for both types of grafts was measured.Results No significant differences were observed between the autograft and allograft groups in the average follow-up time(10.1±2.1 and 10.5±1.8 years)(P=0.376),the SNQ value(24.1±8.8 and 23.2±8.7)(P= 0.652),the Lysholm score(90±10.3 and 89.4±8.9)(P=0.805)and the anterior joint stability dur-ing follow-up(P=0.923).Moreover,the average IKDC score and incidence of abnormal tension of the ligament measured by KT1000 of the autograft group were higher than the allograft group[(84.5±8.3)vs.(80.4±7.8),P=0.075;14.3%vs.8.3%,P=0.724].Meanwhile,ACL re-tear occurred to two cas-es in the autograft group(5.6%)and the allograft group(7.1%),respectively,showing no significant dif-ference(P=0.795).Conclusion Ten years after ACLR,no significant differences are found in graft ma-turity,clinical outcomes,or joint stability between patients using autografts and allografts.Moreover,the rate of graft re-tear is comparable between the two groups.