1.Construction and Clinical Validation of a Deep Learning-Based Automatic Measurement Model for Palmar Tilt and Radial Inclination in Distal Radius Fractures
Guoda DAI ; Jianwei WANG ; Mao WU ; Bin KANG ; Yang SHAO ; Hengyan CUI ; Shaoshuo LI ; Tingchen ZHU ; Zhen HUA ; Zhongming SHEN ; Jintao LIU ; Ming ZHOU
Journal of Traditional Chinese Medicine 2026;67(10):1093-1100
ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine (TCM) clinical scenarios, and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior (AP) and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st, 2023, and September 1st, 2024, via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed, combined with anatomical knowledge specific to TCM orthopedics, to optimize the feature extraction strategy of an artificial intelligence (AI) model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated, and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected, and were divided into a training set (11,144 images, 5066 AP and 6078 lateral), a validation set (3700 images, 1840 AP and 1860 lateral), and an independent test set (600 images, 300 AP and 300 lateral) after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination, when the degree error between AI measurement and manual measurement was <3° and <5°, AI measurement accuracy was 83% and 93%, respectively. In 300 lateral X-rays in the test set for palmar tilt, when AI measurements had an error of <3° and <5° compared to manual measurements, corresponding accuracy rate was 78% and 90%, respectively. For 50 X-ray images, AI measurement time was (1.37±0.05) min for radial inclination while manual measurement time was (22.57±2.52) min (P<0.001); in terms of palmar tilt, the AI measurement time was (1.33±0.14) min, shorter than (23.70±2.80) min for manual measurement time (P<0.001). Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established, enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.
2.Risk factors for low blood pressure in patients with refractory heart failure: a discussion based on comorbidities and clinical indicators
Jiamin ZAN ; Bailing ZHANG ; Fenglai ZHOU ; Shuling ZHANG ; Rong ZHANG ; Tiantian YUAN ; Jingli DAI ; Yuanxin KANG ; Qingqing YANG
Journal of Public Health and Preventive Medicine 2026;37(5):101-105
Objective To analyze the occurrence status of low blood pressure (BP) in patients with refractory heart failure (RHF) and its relationship with comorbidities. Methods A retrospective analysis was conducted on the clinical data of 360 patients with RHF who were hospitalized in department of cardiology of Affiliated Nantong Hospital of Shanghai University from May 2021 to May 2025. These patients were divided into the RHF with BP group and the RHF group based on their blood pressure at admission. The general data and comorbidities were compared between both groups. Multivariate logistic regression analysis was used to identify the risk factors for coexisting BP. Results The heart rate (HR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), blood urea nitrogen, high-sensitivity cardiac troponin T, right atrial diameter, proportion of cardiac function grade IV, use rate of diuretics and prevalence rate of dilated cardiomyopathy (DCM) in the RHF with BP group were higher while the high-density lipoprotein cholesterol (HDL-C), albumin, left ventricular ejection fraction, use rate of lipid-lowering drugs and prevalence rate of coronary heart disease were lower compared to the RHF group, and the differences were statistically significant (P<0.05). Multivariate logistic regression analysis suggested that increased HR (OR=1.685, 95%CI: 1.106-2.569), increased NT-proBNP (OR=1.772, 95%CI: 1.138-2.759), decreased HDL-C (OR=0.605, 95%CI: 0.400-0.917) and DCM (OR=1.956, 95%CI: 1.176-3.255) were independent risk factors affecting BP in RHF patients (P<0.05). Conclusion The incidence rate of low blood pressure in elderly RHF patients is about 19.17%. Increased heart rate, increased NT-proBNP, decreased HDL-C and dilated cardiomyopathy are closely linked to the occurrence of low blood pressure, and they can be used as clinically related factors to identify patients at high risk of low blood pressure.
3.Predictive value of D-dimer for in-hospital mortality and heart failure with reduced ejection fraction in patients with acute myocardial infarction
Jianquan LIAO ; Yinman WANG ; Haibin CHEN ; Yong FU ; Huaxing GAO ; Runda WU ; Zhixiang WANG ; Kang YAO ; Junbo GE
Chinese Journal of Clinical Medicine 2026;33(5):790-796
Objective To investigate the predictive value of D-dimer for in-hospital mortality and heart failure with reduced ejection fraction (HFrEF) in patients with acute myocardial infarction (AMI). Methods A total of 688 patients with AMI who were hospitalized at Zhongshan Hospital, Fudan University, from January 2020 to December 2023 were retrospectively enrolled. Demographic and clinical characteristics, laboratory findings, echocardiographic parameters, and in-hospital outcomes were collected. Patients were divided into four groups according to D-dimer quartiles, and trend tests were used to compare changes in each indicator with increasing D-dimer levels. The primary endpoints were in-hospital mortality and HFrEF. Multivariable logistic regression analysis was performed to assess the independent associations of D-dimer with in-hospital mortality and HFrEF. Receiver operating characteristic (ROC) curve analysis was used to evaluate its predictive performance. Results Differences and trend tests among four groups for age, creatinine, peak cardiac troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction, HFrEF incidence, and in-hospital mortality were statistically significant (P<0.05). Multivariable logistic regression analysis showed that elevated D-dimer was associated with an increased risk of in-hospital mortality in patients with AMI (OR=1.251, 95%CI 1.093–1.432, P=0.001), and HFrEF (OR=1.075, 95%CI 1.028–1.124, P=0.002). ROC curve analysis showed that the area under the curve (AUC) of D-dimer for predicting in-hospital mortality and HFrEF were 0.871 and 0.716, respectively. At a cutoff value of 0.47 mg/L, the sensitivity and specificity of D-dimer in predicting HFrEF were 81.9% and 52.1%, respectively; at a cutoff value of 2.18 mg/L, the sensitivity and specificity of D-dimer in predicting in-hospital mortality were 63.6% and 93.8%, respectively. Restricted cubic spline analysis demonstrated significant non-linear associations between D-dimer and the risks of in-hospital mortality and HFrEF (P<0.001). Conclusions Elevated D-dimer level is significantly associated with increased risks of in-hospital mortality and HFrEF in patients with AMI and shows acceptable predictive performance. As a simple and readily available laboratory biomarker, D-dimer may provide useful information for early risk stratification and clinical management in patients with AMI.
4.Specific extraction and analysis of synthesized proteins from mesenchymal stem cells transplanted into the ischemic heart
Wan-Er LU ; Ying DAI ; Mu-Han TANG ; Kang WEI ; Shu-Jia CHEN ; Huai HUANG ; Jing LIN ; Hao-Rong PENG ; Li-Xuan ZHOU ; Dun-Zheng HAN
Medical Journal of Chinese People's Liberation Army 2025;50(8):991-998
Objective To specifically extract and analyze nascent proteins synthesized by bone marrow mesenchymal stem cells(BMSCs)after transplantation into ischemic hearts using a technique employing mutant methionyl-tRNA synthetase(MetRSL247G)for nascent protein labeling,in order to explore the potential mechanisms of action in BMSCs post-transplantation.Methods Point mutation at position 274 of the MetRS gene in BMSCs was induced via lentiviral infection to enable azidonorleucine(ANL)-mediated labeling of nascent proteins in BMSCs.The labeling efficiency was verified by means of fluorescent non-canonical amino-acid tagging(FUNCAT).Thirty healthy female C57BL/6J mice(8-10 weeks old)were divided into control and experimental groups,with 15 mice in each group.The acute myocardial infarction model was constructed by ligating the left anterior descending coronary artery in experimental group,while control mice underwent only thoracotomy without coronary ligation.After modeling,both groups received intramyocardial injections of MetRSL247G-modified BMSCs(MetRSL247G-BMSCs)at 3 different sites in the peri-infarct ischemic region.Mice were intraperitoneally injected with ANL every 6 hours for 4 times on postoperative days 0,2,and 6(n=5 for each time point)respectively,euthanized 24 h after the last injection,and cardiac tissues were isolated.The newly synthesized and labeled proteins produced by BMSCs after transplantation into the myocardium of experimental and control groups were collected,using an enrichment technique for ANL-tagged proteins and liquid chromatography-tandem mass spectrometry(LC-MS)analysis.Gene ontology(GO)analysis,Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis,protein-protein interaction(PPI)analysis,and heatmap visualization analysis were performed to identify differentially expressed proteins at the 3 time points and screen key pathways and genes.Results Under fluorescence microscopy,the MetRSL247G lentivirus-infected BMSCs were observed to be labelled with mCherry signals,confirming the successful construction of the MetRSL247G-BMSCs cell line.Green fluorescent signals were detected only in nascent proteins in culture medium containing both MetRSL247G-BMSCs and ANL,validating the sensitivity and specificity of the labeling method.GO analysis revealed that differentially expressed proteins were primarily involved in basic cellular biological processes such as extracellular exosome formation,extracellular matrix organization,and focal adhesion.KEGG and PPI analyses indicated that the differential proteins were mainly involved in complement and coagulation cascade pathway,actin cytoskeleton regulation pathway,and apoptosis pathway.Heatmap analysis showed significantly upregulated expression of anti-apoptosis and cell adhesion-related factors in experimental group on day 1(P<0.05),upregulated anti-apoptotic factors,pro-apoptotic factors,and cell adhesion-related factors on day 3(P<0.05),and upregulated anti-apoptotic factors,cell differentiation-related factors,and cell adhesion-related factors on day 7(P<0.05)compared with control group.Expression of apoptosis-inducing factor 1 was significantly downregulated on days 1 and 7(P<0.05).On day 3,most differentially expressed proteins,including anti-apoptosis factors(Protein S100-A11,Clusterin,Gelsolin),pro-apoptosis factor(Cathepsin B),cell differentiation-related factor(Transgelin-2),and cell adhesion-related factors(Cofilin-1,Periostin,Fibronectin)were significantly upregulated(P<0.05).Conclusions The MetRSL247G mutation enables BMSCs to incorporate ANL and synthesize labeled proteins,confirming the feasibility of this nascent protein labeling technique.Nascent proteins of BMSCs in ischemic myocardium primarily contribute to extracellular exosome secretion and extracellular matrix organization.BMSCs may adapt to and respond to ischemic and hypoxic environments by influencing complement and coagulation cascades,activating inflammatory factors,regulating actin cytoskeleton structure,and modulating apoptosis,thereby maintaining the survival of BMSCs.
5.Mechanism of Kaixuan Jiedu Core Prescription in Regulating PTGS2 to Improve Skin Lesions in Psoriasis Mouse Models
Xue XIAO ; Liping KANG ; Dan DAI ; Yidi MA ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):49-59
ObjectiveTo identify the active constituents of Kaixuan Jiedu core prescription (KXJD) and investigate its effective components and therapeutic targets in the treatment of common psoriasis
6.Mechanism of Kaixuan Jiedu Core Prescription in Regulating PTGS2 to Improve Skin Lesions in Psoriasis Mouse Models
Xue XIAO ; Liping KANG ; Dan DAI ; Yidi MA ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):49-59
ObjectiveTo identify the active constituents of Kaixuan Jiedu core prescription (KXJD) and investigate its effective components and therapeutic targets in the treatment of common psoriasis
7.Quality evaluation of Gegen Formula Granules
Dai-liang ZHANG ; Chun-xia WANG ; Lei SHI ; Yu-kang LIU ; Yong-qiang LIN ; Yu-zhuo WANG ; Jing-hua ZHANG ; Jin-xin LI ; Gui-yun CAO ; Zhao-qing MENG
Chinese Traditional Patent Medicine 2025;47(5):1421-1431
AIM To evaluate the quality of Gegen Formula Granules.METHODS Linear calibration with two reference substances(LCTRS)was adopted in the predicting of retention time with puerarin and daidzein as internal standards.UPLC characteristic chromatograms were established.The contents of 3'-hydroxy puerarin,puerarin(internal standard),3'-methoxy puerarin,puerarin 6"-O-xyloside,puerarin apioside and daidzin were determined by quantitative determination analysis multi-components by a single marker(QAMS),after which their transfer rates were calculated.RESULTS Compared with relative retention time method,LCTRS demonstrated higher positional accuracy for characteristic peaks and wider application range for columns.There were 9 characteristic peaks in the characteristic chromatograms for 14 batches of formula granules and 15 batches of standard decoctions with the similarities of more than 0.95.The contents and transfer rates of various constituents in formula granules and standard decoctions were basically consistent.CONCLUSION The chemical constituents in formula granules and their standard decoctions of Puerariae lobatae Radix display good consistency,reliable preparation process is observable in the former.
8.Relationship between lactate level and clearance during extracorporeal life support and prognosis in elderly cardiac intensive care patients
Kewen CHEN ; Xinhua MA ; Kang HUANG ; Huan HUANG ; Songbai WU ; Yao DAI
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2025;27(11):1479-1483
Objective To investigate the presumed correlation between lactate level and clearance during extracorporeal life support(ECLS)and death in elderly cardiac intensive care patients.Methods A total of 93 elderly cardiac intensive care patients who received ECLS in Department of Critical Care Medicine,Xiangya Medical College Affiliated Changsha Hospital,Central South University,from March 2019 to October 2024 were retrospectively included to manage low cardiac production syndrome after major cardiac surgery.According to hospital outcomes,the patients were divided into a death group(n=45)and a survival group(n=48).Blood lactate measurements were performed every 4 hours from the beginning of ECLS treatment to calculate peak lactate and lactate clearance rate(LCR).Routine ICU scores,such as sequential organ failure score(SOFA)and reactive organ dysfunction(ROD)score,and postoperative complications were recorded.Results The death group received larger amounts of packed red blood cell concentrate,fresh frozen plasma and platelet concentrate,and exhibited higher ratios of norepinephrine and epinephrine administration and higher incidences of re-thoracotomy and hemolytic episodes when compared with the survival group(P<0.05,P<0.01).At the end of ECLS,higher SOFA and ROD scores were observed in the death group(P<0.01).The death group also demonstrated higher lactate level from venoarterial ECLS(P<0.001)and increased median peak lactate level,but lower median LCR than the survival group(P<0.01).Multivariate logistic analysis showed that peak lactate and LCR were independent prognostic factors in the elderly cardiac ICU patients(P<0.05,P<0.01).The AUC value(95%CI)of peak lactate and LCR in predicting patient outcomes was 0.723(95%CI:0.615-0.831)and 0.846(95%CI:0.761-0.932),respectively,and the value of their combination in predicting in-hospital death was 0.846(95%CI:0.762-0.931),with a sensitivity of 0.629 and a specificity of 0.937.Conclusion Lactate level and its clearance rate during ECLS can affect the survival rate of elderly cardiac intensive care patients.Peak lactate and LCR can predict the prognosis of elderly cardiac intensive care patients,and can be used as prognostic indicators for clinical monitoring.
9.Analysis of adverse cardiovascular and cerebrovascular outcomes within two years after coronary artery rotational atherectomy in patients with different types of acute coronary syndrome
Xinbo BAI ; Luwa GAO ; Zhe ZHANG ; Jianzhou CHEN ; Zhonghai WEI ; Kun WANG ; Lina KANG ; Biao XU ; Qing DAI
Chinese Journal of Arteriosclerosis 2025;33(4):326-333
Aim To analyze the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)in patients with different types of acute coronary syndrome(ACS)undergoing coronary artery rotational atherec-tomy(RA)within two years.Methods 268 patients with ACS who underwent RA in the Department of Cardiology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School of Nanjing University,between November 2011 and December 2022 were retrospectively included.According to whether ST-segment elevation myocardial infarction(STEMI)occurred,they were divided into 25 cases in the ST-segment elevation myocardial infarction(STEMI)group and 243 cases in the non-ST-segment elevation acute coronary syndrome(NSTE-ACS)group.The NSTE-ACS group included unstable angina pectoris(UAP)and non-STEMI(NSTEMI).The basic information and intraoperative data related to percutaneous coronary intervention(PCI)in the two groups were collected,and the occurrence of MACCE(including car-diovascular death,non fatal myocardial infarction,worsening heart failure,ischemic stroke and target vessel revasculariza-tion)within two years after RA was followed up and analyzed.Results Compared with the NSTE-ACS group,the STEMI group had a higher incidence of MACCE and cardiovascular mortality during the two-year follow-up period(10.3%and 0.4%vs.28.0%and 8.0%;P<0.05).There was no statistical difference between the incidence of target vessel revascularization,nonfatal infarction,ischemic stroke and worsening heart failure between the two groups(P>0.05).According to subgroup analysis based on enrollment periods,the results showed that over time(2011-2017 compared to 2018-2022),the incidence of MACCE in all patients within two years after RA showed a decreasing trend(18.97%vs.6.58%).Combined with previous studies,gender,hypertension,diabetes,renal insufficiency,smoking and left ven-tricular ejection fraction(LVEF)were included in the Cox regression model.It was found that the use of intravascular ul-trasound(IVUS)was an independent factor to reduce the incidence of MACCE in ACS patients within two years after RA(HR=0.333,95%CI:0.153~0.723,P<0.01).Kaplan-Meier analysis showed that among ACS patients undergoing RA,the cumulative incidence of MACCE events was higher in the STEMI group than that in the NSTE-ACS group(P<0.05).Conclusion STEMI patients have a higher incidence of MACCE and cardiovascular mortality within two years after RA compared to NSTE-ACS patients,and the use of IVUS during RA surgery can reduce the incidence of MACCE in ACS patients after RA.
10.The role of surface electromyography network indices in assessing neuromuscular dysfunction in hemiplegia
Jinping LI ; Ying XU ; Xianglian KANG ; Runing JI ; Juan WANG ; Minjun DAI ; Ke LI ; Ying HOU
Chinese Journal of Physical Medicine and Rehabilitation 2025;47(5):446-452
Objective:To observe the characteristics of multi-muscle surface electromyography (sEMG) network indices during static standing among hemiplegic stroke survivors, and to evaluate the value of the indices in assessing neuromuscular dysfunction.Methods:Ten male stroke survivors with hemiplegia were recruited into the hemiplegia group, and 10 age-matched healthy males were chosen as the control group. Both groups were required to perform 30s static standing tasks with their eyes open and closed. The sEMG signals from the bilateral gluteus maximus (GM), rectus femoris (RF) and biceps femoris (BF) muscles were synchronously collected. Linear time-frequency domain indices were then calculated from the sEMG signals, including the root mean square (RMS) and median frequency (MF). Network indices were extracted from the multiplex recurrence network and weighted networks were constructed from the sEMG signals, including the average interlayer mutual information (I), average edge overlap (ω), clustering coefficient (C), average shortest path length (L) and degree of centrality (DC).Results:With the eyes closed, the RMS values of the bilateral GMs of the hemiplegia group, as well as the values for the RF and BF on the unaffected side were significantly higher than the control group′s values. In the hemiplegia group, the RMS values of the RF and BF muscles on the unaffected side were significantly higher than on the affected side during standing with the eyes closed. For the RF muscles the RMS values on the unaffected side were, on average, significantly higher than with the eyes open. The MF of the GM muscles on the unaffected side in the hemiplegia group was significantly lower than the average MF values of the bilateral GM muscles in the control group with the eyes open or closed. With the eyes closed, the MF of the unaffected-side GM was significantly lower than that of the affected-side GM in the hemiplegia group. Compared with the control group, the hemiplegia group showed a significant increase in I and ω values, but a significant decrease in L values with the eyes open or closed. The DC values of the bilateral GM, RF and BF muscles in the hemiplegia group were significantly higher than among the control group with the eyes open, which was also true of the bilateral GM and RF muscles with the eyes closed. With the BF muscles it was true only of the unaffected side. In the hemiplegia group, the DC values of the unaffected-side GM with the eyes open or closed, and of the unaffected-side BF with the eyes closed.Conclusions:When standing still, hemiplegic stroke survivors exhibit increased overall synchronous muscle adjustment with involvement of unaffected-side muscles, especially the GM. sEMG network indices such as I, ω, L and DC can assess multi-muscle synchronous adaptability and the involvement of single muscles. sEMG network algorithms thus have potential as a new method for localizing and quantitatively assessing neuromuscular dysfunction among such patients.


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