Objective To explore the early detection value of estimated glucose disposal rate(eGDR)for non-alcoholic fatty liver disease(NAFLD),providing a simple tool for precise clinical intervention.Methods A cross-sectional analysis was conducted on totally 3 262 participants with complete data from the National Health and Nutrition Survey Database of the United States from 2007 to 2018.Univariate regression and multivariate logistic regression analyses were used to explore the correlation between the estimated glucose treatment rate and the incidence of non-alcoholic fatty liver disease.Subgroup analysis,restricted cubic spline and threshold effect analysis were conducted to investigate the potential factor influences and nonlinear relationships.Result Among all the included populations,948 cases(25.29%)were diagnosed with NAFLD,and the number gradually decreased with the increase of the estimated glucose treatment rate(P<0.001).Multivariate logistic regression showed that the estimated grape processing rate was negatively correlated with non-alcoholic fatty liver disease(OR=0.86,95%CI:0.83～0.88,P<0.001),and when the estimated glucose processing rate was≥10.246,it could significantly reduce the risk of non-alcoholic fatty liver disease(OR=0.20,95%CI:0.10～0.39,P<0.001),and stratified analysis further confirmed this result.Conclusion The eGDR is significantly associated with the incidence risk of NAFLD.A higher eGDR indicates a lower risk of NAFLD.This implies that in clinical practice,the risk of disease detection can be quantified through this indicator,thereby identifying potential patients earlier and initiating intervention.Countermeasures As decision-makers,they should strengthen public health education on non-alcoholic fatty liver disease,reduce health risks by promoting healthy diets and lifestyle interventions,and pay attention to the cardiovascular health of high-risk groups for non-alcoholic fatty liver disease.At the same time,promote the research and application of drugs,and dynamically adjust policies through continuous disease monitoring to comprehensively reduce the burden of non-alcoholic fatty liver disease.

Objective To explore the value of CT-enhanced portal venous phase radiomics combined with machine learning algo-rithms in assessing microvascular invasion(MVI)in hepatocellular carcinoma(HCC).Methods A retrospective analysis was con-ducted on imaging and clinical data of 132 HCC patients.The patients were randomly divided into training set and test set at a 7︰3 ratio.Independent influencing factors for predicting MVI status in HCC patients were identified through univariate and multivariate logistic regression analyses.Radiomics features were selected using the least absolute shrinkage and selection operator(LASSO)algorithm,and a Radiomics score(Radscore)was calculated to construct the final combined model.Four machine learning algorithms including-logistic regression(LR),naive Bayes(NB),support vector machine(SVM),and K-nearest neighbor(KNN)were applied to evaluate the model.The performance of each machine model was assessed using the receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results Univariate and multivariate logistic regression analyses revealed that venous phase CT values were independentinfluencing factors,and six radiomics features were ultimately selected.After the Radscore was calculated,a combined model was constructed using Radscore and venous phase CT values.Machine learning algorithms showed that the combined model achieved the following AUC in the training set:0.895[95%confidence interval(CI)0.821-0.965]for LR,0.892(95%CI 0.831-0.963)for NB,0.644(95%CI 0.532-0.765)for SVM,and 0.855(95%CI 0.783-0.947)for KNN.In the test set,the respective AUC were 0.845(95%CI 0.712-0.961),0.840(95%CI 0.723-0.964),0.492(95%CI 0.311-0.687),and 0.716(95%CI 0.566-0.871).Conclusion Radiomics based on CT-enhanced portal venous phase combined with machine learning algorithms demonstrates high efficiency in preoperative evaluation of MVI in HCC,with the LR model showing the best performance.

Objective To explore the value of CT-enhanced portal venous phase radiomics combined with machine learning algo-rithms in assessing microvascular invasion(MVI)in hepatocellular carcinoma(HCC).Methods A retrospective analysis was con-ducted on imaging and clinical data of 132 HCC patients.The patients were randomly divided into training set and test set at a 7︰3 ratio.Independent influencing factors for predicting MVI status in HCC patients were identified through univariate and multivariate logistic regression analyses.Radiomics features were selected using the least absolute shrinkage and selection operator(LASSO)algorithm,and a Radiomics score(Radscore)was calculated to construct the final combined model.Four machine learning algorithms including-logistic regression(LR),naive Bayes(NB),support vector machine(SVM),and K-nearest neighbor(KNN)were applied to evaluate the model.The performance of each machine model was assessed using the receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results Univariate and multivariate logistic regression analyses revealed that venous phase CT values were independentinfluencing factors,and six radiomics features were ultimately selected.After the Radscore was calculated,a combined model was constructed using Radscore and venous phase CT values.Machine learning algorithms showed that the combined model achieved the following AUC in the training set:0.895[95%confidence interval(CI)0.821-0.965]for LR,0.892(95%CI 0.831-0.963)for NB,0.644(95%CI 0.532-0.765)for SVM,and 0.855(95%CI 0.783-0.947)for KNN.In the test set,the respective AUC were 0.845(95%CI 0.712-0.961),0.840(95%CI 0.723-0.964),0.492(95%CI 0.311-0.687),and 0.716(95%CI 0.566-0.871).Conclusion Radiomics based on CT-enhanced portal venous phase combined with machine learning algorithms demonstrates high efficiency in preoperative evaluation of MVI in HCC,with the LR model showing the best performance.

OBJECTIVE: To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique. METHODS: From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function. RESULTS: Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(<0.05). CONCLUSIONS Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.
Aged ; Aged, 80 and over ; Bone Plates ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted ; Humans ; Male ; Middle Aged ; Shoulder ; Shoulder Fractures ; surgery ; Treatment Outcome

OBJECTIVETo investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III.

METHODSFrom March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function.

RESULTSAll patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred.

CONCLUSIONSInternal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.

Objective: To explore the impact of atrial fibrillation (AF) on clinical outcomes in patients with cardiac resynchronization therapy (CRT). Methods: A total of 258 arrhythmia patients who received CRT in our hospital from 2010-01 to 2014-12 were retrospectively enrolled. According to AF occurrence, the patients were divided into 2 groups: AF group,n=42 and Non-AF group,n=216. The end point events were deifned by heart failure (HF) re-admission and all-cause death (including heart transplantation). Survival curve was drawn by Kaplan-Meier method, clinical prognosis was comparedbetween 2 groups with log-rank test and the impact of AF on end point prediction was analyzed by uni- and multivariate Cox proportional-hazards regression models. Results: There were 16.3% (42/258) patients combining AF. The following indexes were statistically different between AF group and Non-AF group: patients' age, the ratios of male gender and left bundle branch block (LBBB), eGFR, blood levels of creatinine, uric acid, big endothelin-1, left atrial diameter and application of amiodarone. With the median of 22 months follow-up study, there were 33/258 (12.8%) patients died, 5 (1.9%) received heart transplantation and 72 (27.9%) with HF re-admission. Survival analysisindicated that HF re-admission rate in AF group was higher than Non-AF group (χ2=6.651,P=0.010), all cause mortality was similar between 2 groups (χ2=0.528,P=0.468). Univariate Cox proportional-hazards regression analysis showed that AF, LBBB, higher blood levels of creatinine, big endothelin-1 and large left atrium were the suspiciousrisk factors for HF re-admission; increased blood levels of creatinine, big endothelin-1 and large left atrium were thesuspiciousrisk factors for all cause death. Multivariate Cox proportional-hazards regression analysis presented that AF was not the independent risk factor for HF re-admission and all-cause death, while largeleft atrium was the independent risk factor for HF re-admission (HR=1.041, 95% CI 1.007-1.075,P=0.018); large left atrium and increased serum creatinine were the independent risk factors for all cause death (HR=1.045, 95% CI 1.001-1.091,P=0.048) and (HR=1.008, 95% CI 1.001-1.015,P=0.035) respectively. Conclusion: AF was associated with the higher rate of HF re-admission in CRT patients; while no clear evidencesupported that AF was the independent risk factor for HF re-admission and all cause death in CRT patients.

Apoptosis and autophagy are common life phenomenon in various cells, which widely involve in physiological and path-ological processes, and interact with one another by many factors and multiple pathways. This intricate relationship runs through a vari-ety of cardiovascular diseases, and plays an important role in the occurrence, development and prognosis of many cardiovascular disea-ses. The effects of apoptosis and autophagy and their interrelationship in cardiovascular diseases were reviewed and summarized in this paper.

Objective: To create and validate a scoring system for predicting clinical prognosis in patients with cardiac resynchronization therapy (CRT). Methods: A cohort of 367 consecutive patients received CRT in our hospital from 2010-01 to 2015-12 were enrolled. The endpoint follow-up events were all-cause death including heart transplantation and heart failure re-admission. The patients were randomly categorized into 2 groups: Modeling group, to develop HEAL scoring system,n=300 and Veriifcation group, to validate HEAL model,n=67. HEAL system was established by Cox proportional hazards regression model, discrimination between HEAL and EARRN scoring systems was evaluated by AUC of ROC, HEAL calibration was assessed by Hosmer-Lemeshow test and clinical endpoint evaluation by 2 scoring systems were compared by Kaplan-Meier method. Results: Modeling group analysis indicated that hs-CRP (HR=1.137, 95% CI 1.072-1.205,P<0.001), big endothelin-1 (HR=1.934, 95% CI 1.066-3.507,P=0.03), left atrial diameter (HR=1.045, 95% CI 1.007-1.084,P=0.02) and NYHA IV (HR=2.583, 95% CI 1.331-5.013,P=0.005) were the independent risk factors of adverse prognosis in CRT patients. Based on β partial regression coefifcient, HEAL scoring system was established to classify the patient's risk levels: low risk<4, moderate risk 4-10 and high risk>10. AUC for risk classification in Modeling group and Verification group were 0.719(95% CI 0.629-0.809) and 0.708 (95% CI 0.539-0.878), HEAL can well distinguish clinical prognosis in patients at different risk levels (log-rank test showed in Modeling groupP<0.001 and in Veriifcation groupP=0.002); Hosmer-Lemeshow test presented good calibration,P=0.952. All 367 patients were respectively evaluated by HEAL and EARRN scoring systems, HEAL had the better discrimination than EARRN as AUC 0.763 (95% CI 0.692-0.833) vs AUC 0.602 (95% CI 0.517-0.687). Conclusion: HEAL scoring system can effectively predict adverse prognosis in CRT patients, it had the better discrimination than EARRN system and was valuable to distinguish high risk patients in clinical practice.

Objective: To assess the relationship between serum albumin level and clinical outcome in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). Methods: In this retrospective cohort study, 357 consecutive chronic heart failure patients receiving CRT between January 2010 and December 2015 were enrolled and divided into two groups based on pre-CRT serum albumin (albumin≥40 g/L, n=244; albumin<40 g/L, n=113). Clinical outcomes were defined as all-cause mortality (including heart transplantation) and rehospitalization due to worsening HF.Baseline characteristics were compared and all-cause mortality (including heart transplantation) and rehospitalization due to worsening heart failure (HF) were analyzed using Kaplan-Meier curves.Prognostic value of albumin level was evaluated in Cox proportional-hazards regression models. Results: Over a median follow-up time of 21 months, 45 patients (12.6%) died, 4 patients (1.1%) underwent heart transplantation and 100 patients (28.0%) were rehospitalized due to worsening HF. HF patients with pre-CRT albumin<40 g/L were related with worse NYHA function class, lower HDL-C level and ACEI/ARB use compared to HF patients with pre-CRT albumin≥40 g/L. Kaplan-Meier analyses evidenced lower survival rate in HF patients (log-rank test: P=0.000 4, χ²=12.60) and higher rehospitalization rate due to worsening HF (log-rank test: P=0.009, χ²=6.82) in HF patients with pre-CRT albumin<40 g/L.Multivariate Cox analyses indicated that serum pre-CRT albumin <40 g/L was an independent risk factor for all-cause mortality (HR=2.019, 95%CI 1.125-3.622, P=0.018) and HF rehospitalization (HR=1.517, 95%CI 1.014-2.270, P=0.043). Conclusion Pre-CRT serum albumin level is associated with the severity of heart failure in CRT recipients.Patients with lower pre-CRT albumin level face increased risk of all-cause mortality and HF rehospitalization in chronic heart failure patients receiving cardiac resynchronization.

OBJECTIVETo study therapeutic effects of anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow.

METHODSFrom November 2009 to March 2013,17 patients with terrible triad of elbow were treated through anteromedial approach combined with lateral approach. There were 11 males and 6 females, with an average age of 36.6 years old, ranging from 22 to 68 years old. Ten patients had fractures in the left side and 7 patients had fractures in the right side. All of which were close fractures. Coronoid process fractures were reduced and treated with internal fixation through the anteromedial approach, and the incision was located between radiocarpus and cubitalis grailis. In order to expose the lateral collateral ligament joint capsule and capitulum radii, Kocher approach was used with the incision between triceps brachii muscle and brachioradialis muscle along condylus lateralis humeri, down to posterior side between anconeus muscle and extensor carpi ulnaris muscle. Then capitulum radii fractures were treated with internal fixation using miniature plates and screws, and lateral collateral ligament complexes were repaired using fasciole rivets. Mayo elbow performance score (MEPS) was used to evaluate clinical effects at the latest follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 13 to 24 months,with a mean of 12.4 months. At the latest follow-up, the average flexion angle of all patients was (134.0 ± 8.8) degrees; the average extension angle was (6.4 ± 2.3) degrees. According to the Mayo criteria system, the average total score was 91.8 ± 7.9, including pain score 42.4 ± 5.9, range of motion score 17.6 ± 2.6, joint stability score 9.7 ± 1.2, and functional score 22.1 ± 2.5; 13 patients got an excellent result and 4 good. Two patients had transient ulnar nerve palsy, and 1 patient had heterotopic ossification. There were no complications such as infection, nonunion, elbow residual instability, dislocation and elbow stiffness.

CONCLUSIONThe operation through anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow has advantages of providing both bone and soft-tissue stability simultaneously, allowing early exercise and improving early functional recovery.

Adult ; Aged ; Elbow Joint ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Ulna Fractures ; physiopathology ; surgery