Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

Objective To compare the long-term prognosis differences between surgical radical resection and endoscopic resection for early gastric cancer patients based on the SEER database. Methods A total of 1 437 patients with stage Tis to T_1b gastric adenocarcinoma were selected from the SEER database from January 1, 2004 to December 31, 2013. They were divided into a surgery group (n=1 257) and an endoscope group (n=180) according to the treatment method. Kaplan-Meier survival curve and Cox regression model were used to analyze survival outcomes. Results The patients in the surgery group were younger than those in the endoscope group ([67.63±12.97] years old vs [71.29±10.82] years old), with higher rates of T₁ stage (97.45% vs 87.78%) and lymph node metastasis (19.73% vs 5.00%, all P＜0.001). The median follow-up time for all patients was 37 (15, 66) months, and the mortality rate of gastric cancer in the endoscope group was lower than that in the surgery group (23.33% vs 27.13%, P＜0.001). Univariate Cox analysis showed that treatment modality, age, sex, T stage, lymph node metastasis were all associated with early gastric cancer mortality (all P＜0.05), and the risk of death in the endoscope group was 43% of that in the surgery group (HR=0.43, P=0.015). After adjusting for multiple factors, there was no statistically significant difference in mortality risk between the two groups (P=0.067), but after excluding lymph node positive patients, the mortality risk in the endoscope group was 46% of that in the surgery group (HR=0.46, P=0.048). Conclusions For early gastric cancer patients with negative lymph nodes, endoscopic resection may provide better survival benefits than surgical procedures, suggesting that it can be the preferred treatment strategy for patients with low risk of lymph node metastasis.

AIM To investigate the effects of Heixiaoyao Powder on neuroinflammation in APP/PS1 transgenic mice.METHODS The 16-week-old male APP/PS1 transgenic mice were randomly divided into the model group,the BBG group(P2X7R specific antagonist,30 mg/kg)and high,medium and low dose Heixiaoyao Powder groups of(22.10,11.05,5.53 g/kg),in contrast to the male C57BL/6J mice of the same age and the same strain of the blank groups,with 12 mice in each group.When normal saline by gavage was dosed upon the blank group and the model group,and the other groups were treated with corresponding drug by gavage.After 90 days of administration,the mice had their learning and memory ability detected by Morris water maze test;their hippocampal pathological changes observed with HE staining;their MyD88 expression detected by immunofluorescence staining;their hippocampal levels of pro-inflammatory factors(TNF-α,IL-6),anti-inflammatory factors(IL-10),ATP and amyloid protein β(Aβ)detected by ELISA;their hippocampal mRNA expressions of P2X7R,TLR4,MyD88 and NF-κB-P65 detected by RT-qPCR method;and their hippocampal protein expressions of P2X7R,TLR4,MyD88,NF-κB-P65 and p-NF-κB-P65 detected by Western blot.RESULTS Compared with the blank group,the model group demonstrated prolonged escape latency and reduced frequency in crossing platform(P＜0.01);decreased number of hippocampal neurons,deranged neurons,and darker cytoplasm staining;increased immunofluorescence expression of hippocampal MyD88(P＜0.01);decreased IL-10 level(P＜0.01);increased levels of TNF-α,IL-6,ATP and Aβ(P＜0.01);increased mRNA and protein expressions ofP2X7R,TLR4 and MyD88(P＜0.01),and increased protein expression of p-NF-κB-P65(P＜0.01).Compared with the model group,the groups intervened with Heixiaoyao Powder or BBG demonstrated shortened escape latency and increased frequency in crossing platform(P＜0.01);more number of neatly arranged hippocampal neurons;increased hippocampal IL-10 level(P＜0.01),decreased levels of TNF-α,IL-6,ATP and Aβ(P＜0.05,P＜0.01);decreased mRNA and protein expressions of P2X7R,TLR4 and MyD88(P＜0.05,P＜0.01);and decreased protein expression of p-NF-κB-P65(P＜0.05,P＜0.01).Except the low dose Heixiaoyao Powder group,the other treatment groups shared decreased immunofluorescence expression of MyD88(P＜0.05,P＜0.01).CONCLUSION Heixiaoyao Powder can significantly improve the learning and memory ability of APP/PS1 model mice,and its mechanism may lie in its function in alleviating cerebral neuroinflammation by reducing the abnormal Aβ aggregation via inhibiting the activation of ATP/P2X7R/NF-κB signaling pathway.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective To explore the effect of different ways of out-of-plane shield on the tube current and cumulative radiation dose of CT scan.Methods The CT water membrane was scanned using Philips 128 row iCT scanner in different scanning methods:the 1-3 times,without the out-of-plane shield,the total length of localizer was 150 mm,270 mm,and 390 mm,respectively;the fourth time,the out-of-plane shield was used but was not present in the localizer;from the 5th to 7th pass,with out-of-plane shield and develop it in the localizer,with out-of-plane shield development lengths of 60 mm,180 mm,and 300 mm,respectively,and the out-of-plane shield was not within the formal scanning range.The tube current and cumulative radiation dose of various scanning methods were compared and a line graph of the tube current for scanning each layer was figured.Results(1)There was no statistically significant difference in tube current when there was no out-of-plane shield but the length of the localizer was different(P＞0.05).(2)When the pitch was 0.8,1.0,and 1.15 respectively,with out-of-plane shield but no shield object in the localizer,the scanning tube current was lower than that without shield scanning(P＜0.05).(3)When scanning with three different lengths of out-of-plane shield(60 mm,180 mm,300 mm)in the localizer,regardless of the pitch,the tube current was greater than that of unshield scanning(P＜0.05).(4)When there was a shield in the localizer,the closer to the shield,the higher the tube current in the formal scan.(5)The cumulative dose of scans with out-of-plane shield but without the presence of shield in the localizer was smaller than that of unshield scanning.However,with shield and the presence of shield scanning in the localizer,the cumulative radiation dose was greater than that of unshield scanning.Conclusion The presence of out-of-plane shield in the localizer may increase the tube current and radiation dose for formal scanning,and the closer to the shield,the more significant the increase in tube current.

Phototherapy plays a significant role in vitiligo treatment.Narrow-band ultraviolet B(NB-UVB)remains the first-line phototherapy for non-segmental vitiligo in clinical practice.In recent years,visible light has emerged as a novel therapeutic approach for vitiligo.Studies indicate that helium-neon laser demonstrates superior efficacy in segmental vitiligo,blue light is more effective for localized vitiligo,and NB-UVB is better suited for generalized or extensive vitiligo.Different phototherapy modalities exhibit distinct mechanisms of action,involving multiple biological proteins and signaling pathways in melanocyte activation and repigmentation.This review sum-marizes recent advances in phototherapy for vitiligo treatment.

The ocular surface is composed of a variety of tissues,of which limbal stem/progenitor cells(LSCs)are es-sential for maintaining the steady state of the ocular surface.Once LSCs become diseased,resulting in limbal corneal stem cell deficiency(LSCD),the ocular surface epithelial cells will change their cellular identity through processes such as epi-thelial-mesenchymal transition(EMT),transdifferentiation and dedifferentiation.Cell differentiation is tightly controlled by genetic programming and plays a key role in the transformation of the cellular state.The EMT process allows epithelial cells to exhibit mesenchymal cell characteristics,which may cause subepithelial fibrosis in corneal disease and is regulated by a variety of factors.Transdifferentiation is the transformation of one type of differentiated cell into another.In ocular surface stress,conjunctival epithelium may be transformed into corneal epithelium,and non-ocular surface cells may be trans-formed into corneal epithelium,but this process faces ethical and cellular stability challenges.Dedifferentiation,on the other hand,refers to the restoration of a differentiated cell's ability to divide and differentiate,and ocular surface cells also undergo de-differentiation under certain conditions and may be involved in the repair process of the ocular surface.Inten-sive study of these cellular changes provides new ideas for the treatment of ocular surface diseases,although the exact mechanisms are not yet fully understood.Microenvironmental signaling plays a crucial role in this process,so care must be taken when applying the findings to avoid triggering other pathological changes.

Objective To investigate the classification capability of a deep learning classification model based on biparametric mag-netic resonance imaging(bpMRI)for clinically significant prostate cancer(csPCa)and clinically insignificant prostate cancer(cisPCa).Methods A retrospective analysis was conducted on the data of 565 prostate bpMRI patients.A deep learning classification model was established for csPCa.The patients were randomly divided into training set(452 cases)and internal test set(113 cases)at a ratio of 8︰2.Internal validation was performed,followed by external validation(external validation set)using data from 120 patients across four different hospitals.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve,F1 score,precision,sensi-tivity,specificity,accuracy,and calibration curves were used to evaluate the model.Decision curve analysis(DCA)was also applied to assess the clinical benefit of the model.Results The deep learn-ing classification model for csPCa classification demonstrated the following performance across the training set,internaltest set,and external validation set:sensitivity of 0.986,0.887,and 0.750;specificity of 0.967,0.850,and 0.976;precision of 0.963,0.839,and 0.818;accuracy of 0.974,0.862,and 0.792;F1 score of 0.974,0.862,and 0.783;and AUC of 0.998,0.896,and 0.883,respec-tively.The calibration curves for all three datasets showed high consistency between predicted and actual probabilities.DCA indicated that the highest net benefit threshold probabilities for the training set,internal test set,and external validation set were 0.2-0.7,0.2-0.6,and 0.2-0.5,respectively.Conclusion The deep learning classification model demonstrated excellent performance in classifying csPCa and exhibited good generalizability,which is worhty of clinical application.

The ocular surface is composed of a variety of tissues,of which limbal stem/progenitor cells(LSCs)are es-sential for maintaining the steady state of the ocular surface.Once LSCs become diseased,resulting in limbal corneal stem cell deficiency(LSCD),the ocular surface epithelial cells will change their cellular identity through processes such as epi-thelial-mesenchymal transition(EMT),transdifferentiation and dedifferentiation.Cell differentiation is tightly controlled by genetic programming and plays a key role in the transformation of the cellular state.The EMT process allows epithelial cells to exhibit mesenchymal cell characteristics,which may cause subepithelial fibrosis in corneal disease and is regulated by a variety of factors.Transdifferentiation is the transformation of one type of differentiated cell into another.In ocular surface stress,conjunctival epithelium may be transformed into corneal epithelium,and non-ocular surface cells may be trans-formed into corneal epithelium,but this process faces ethical and cellular stability challenges.Dedifferentiation,on the other hand,refers to the restoration of a differentiated cell's ability to divide and differentiate,and ocular surface cells also undergo de-differentiation under certain conditions and may be involved in the repair process of the ocular surface.Inten-sive study of these cellular changes provides new ideas for the treatment of ocular surface diseases,although the exact mechanisms are not yet fully understood.Microenvironmental signaling plays a crucial role in this process,so care must be taken when applying the findings to avoid triggering other pathological changes.

Objective To investigate the classification capability of a deep learning classification model based on biparametric mag-netic resonance imaging(bpMRI)for clinically significant prostate cancer(csPCa)and clinically insignificant prostate cancer(cisPCa).Methods A retrospective analysis was conducted on the data of 565 prostate bpMRI patients.A deep learning classification model was established for csPCa.The patients were randomly divided into training set(452 cases)and internal test set(113 cases)at a ratio of 8︰2.Internal validation was performed,followed by external validation(external validation set)using data from 120 patients across four different hospitals.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve,F1 score,precision,sensi-tivity,specificity,accuracy,and calibration curves were used to evaluate the model.Decision curve analysis(DCA)was also applied to assess the clinical benefit of the model.Results The deep learn-ing classification model for csPCa classification demonstrated the following performance across the training set,internaltest set,and external validation set:sensitivity of 0.986,0.887,and 0.750;specificity of 0.967,0.850,and 0.976;precision of 0.963,0.839,and 0.818;accuracy of 0.974,0.862,and 0.792;F1 score of 0.974,0.862,and 0.783;and AUC of 0.998,0.896,and 0.883,respec-tively.The calibration curves for all three datasets showed high consistency between predicted and actual probabilities.DCA indicated that the highest net benefit threshold probabilities for the training set,internal test set,and external validation set were 0.2-0.7,0.2-0.6,and 0.2-0.5,respectively.Conclusion The deep learning classification model demonstrated excellent performance in classifying csPCa and exhibited good generalizability,which is worhty of clinical application.