Objective:To compare knowledge graphs (KGs) constructed from standardized clinical pathways and actual examination records within 24 hours of emergency care for acute gastrointestinal hemorrhage (AGH), acute myocardial infarction (AMI), and intracerebral hemorrhage (ICH), and to visually analyze discrepancies between guideline recommendations and real-world practice, thereby exploring a novel methodology for clinical pathway optimization.Methods:KGs were developed using clinical pathway standards and actual examination data collected within the first 24 hours of emergency treatment for AGH, AMI, and ICH. Entity attributes were weighted to visually represent the frequency and extent of examination usage through variable node sizes in the KG. The constructed KGs were used to compare and analyze the differences in type and frequency of examinations performed relative to pathway standards.Results:The proportion of examination items with >50% adherence to clinical pathway standards within 24 hours was 76.92% for AGH, 44.44% for AMI, and 78.57% for ICH. Items from the clinical pathways that were not performed in over 50% of patients accounted for 15.38%, 27.78%, and 21.43% of cases, respectively. Non-pathway examinations increased by 9, 7, and 4 items for each condition, of which 17 items (85%) were performed at least once in more than half of the patients. Visualization via KGs revealed a reduction in redundant examinations by 38.64% between AGH and AMI, 35.00% between AGH and ICH, and 37.50% between AMI and ICH. Overall, a 54.84% reduction in redundant examinations was achieved across all three critical conditions.Conclusions:The visual KG approach effectively integrates both guideline-recommended and experience-driven examinations, serving as a correlational analysis tool to assess deviations between actual clinical practice and standardized pathways. It provides a quantitative foundation for optimizing clinical pathways, with potential for greater efficiency gains as more critical conditions are incorporated into the graph.

Objective To investigate the impact of scenario class teaching on language expression,communication skills,and final exam performance of non-clinical majors students in the course of Medical Parasitology.Method Undergraduate students of non-clinical medical programs from Kunming Medical University in 2022 were selected as the subjects and randomly divided into a scenario class group and a non-scenario class group.Questionnaires were administered to compare the two groups regarding their interest in the laboratory classes,enjoyment levels,and knowledge retention.Additionally,the final exam scores of the two groups were compared.Results Students in the scenario class group showed significantly higher interest(82.6%)and enjoyment levels(88.3%)for laboratory classes compared to the non-scenario class group(73.0%and 60.1%,respectively,P<0.05).Students in the scenario class group believed that situational teaching enhanced their self-learning ability(82.06%),interest in learning(83.2%),willingness to express themselves(83.2%),confidence in expression(81.8%),and communication skills(87.9%).Additionally,It effectively facilitated their understanding of the occurrence and development of parasitic diseases(85.9%)and familiarity with the diagnosis and treatment process(86.8%),thereby cultivating clinical thinking.In terms of final exam scores,the scenario class group had a higher average score(22.80±0.18)than the non-situational classroom group(21.47±0.17,P<0.05).Conclusion Sc-enario class teaching in Medical Parasitology can effectively improve students'self-learning ability,language expression,and communication skills,cultivate clinical thinking,and enhance academic performance,demonstrating significant teaching advantages.

Objective To investigate the therapeutic effects and mechanisms of Huangqi Jianzhong Decoction(HJD)on gastric mucosal injury induced by Helicobacter pylori(Hp)infection.Methods A Wistar rat model of Hp-induced gastric mucosal injury was established.Successfully modeled rats were randomly divided into five groups:model group,low-,medium-and high-dose HJD groups,and quadruple therapy group(Omeprazole+Amoxicillin+Clarithromycin+Colloidal Bismuth pectin),8 rats per group,with an additional normal group.After 4 weeks of treatment,gastric mucosal pathological changes were assessed by hematoxylin-eosin(HE)staining.Serum levels of interleukin 1β(IL-1β),interleukin 18(IL-18),tumor necrosis factor α(TNF-α),chemokine(C-X-C motif)ligand 1(CXCL1),chemokine(C-X-C motif)ligand 9(CXCL9),and gastrin-17(G-17)were measured by enzyme-linked immunosorbent assay(ELISA).Protein expression levels of IRF8,IFN-γ,interferon-induced tetratricopeptide repeat protein 3(Ifit3)and uridine phosphorylase 1(Upp1)in gastric mucosal tissues were detected by Western Blot.Results Compared with the normal group,the model group exhibited significant gastric mucosal damage,serum levels of IL-1β,IL-18,TNF-α,CXCL1 and CXCL9 were significantly increased,G-17 was drcreased,and protein expression levels of IRF8,IFN-γ,Ifit3 and Upp1 in gastric mucosa were significantly increased,the differences being statistically significant(P＜0.05).Compared with the model group,the gastric mucosal tissue injury of rats in the medium-and high-dose of HJD groups and the quadruple therapy group was significantly improved,the levels of IL-1β,IL-18,TNF-α,CXCL1 and CXCL9 in serum were significantly decreased,G-17 was significantly increased,and the protein expression levels of IRF8,IFN-γ,Ifit3 and Upp1 in gastric mucosa were significantly decreased,the differences being statistically significant(P＜0.05).The effect in above indexes in high-does HJD groups was superior to the low-and mediun-groups.Conclusion HJD alleviates Hp-induced gastric mucosal injury by inhibiting the IRF8/IFN-γ signaling pathway and subsequent inflammatory responses.

Ulcerative colitis(UC)is a chronic autoimmune disease characterized primarily by impaired intestinal mucosal barrier function.Beneficial bacteria in the intestinal flora are crucial for maintaining intestinal function.Therefore,eliminating harmful bacteria,promoting the regeneration of beneficial bacteria,and reconstructing the intestinal mucosal barrier have become key strategies in the treatment of UC.The traditional Chinese medicine(TCM)"Houchang Theory"elucidates the mech-anism of ulcer formation from the perspective of the"Zhimo"(lipid membrane)structure and a-chieves the purpose of treating UC by thickening the"Zhimo"through syndrome differentiation and treatment.This theory is consistent with the modern medical concept of reconstructing the intestinal mucosal barrier.Fecal microbiota transplantation(FMT),as a transformed product of TCM"Jinzhi"(liquid feces),has been proven to have significant efficacy in the treatment of UC.Based on the TCM"Houchang Theory"and from the perspective of the intestinal mucosal barrier,this article explored the mechanism of"Jinzhi"FMT in the treatment of UC and provides new strategies for clinical treatment.

Objective:To investigate the value of a computed tomography(CT)radiomics-based model for predicting the efficacy of neoad-juvant immunotherapy combined with chemotherapy for locally advanced gastric cancer(LAGC).Methods:Data on 114 patients with LAGC who underwent radical surgery after neoadjuvant immunotherapy combined with chemotherapy at The Second Affiliated Hospital of Xingtai Medical College between June 2019 and June 2021 were retrospectively collected.These patients'data were divided into a training set(n=67)and a validation set(n=47)based on the time of admission.High-throughput features were extracted from baseline portal phase CT images of all patients,and the selected features were used to construct the radiomics prediction model.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)and calibration curves.The prognostic ability of the model was assessed using Kaplan-Meier curves.Results:Based on the maximum relevancy min-redundancy(mRMR)algorithm and least absolute shrinkage and selection operator(LASSO)regression model,5 out of 584 assessed features were incorporated into the radiomics(Rad)score.The respect-ive areas under the curve for predicting pathological complete response(pCR)in the training and validation sets were 0.865 and 0.830,re-spectively,and good fits were obtained(Hosmer-Lemeshow test:P>0.05).The optimal cut-off value for the Rad score was determined based on the Youden index.Patients with high Rad scores had significantly higher 3-year recurrence-free survival rates(82.7%vs.60.4%in the training set and 78.9%vs.53.8%in the validation set)and 3-year overall survival rates(78.9%vs.60.2%in the training set and 79.3%vs.50.0%in the validation set)than those with low Rad scores(P<0.05).Conclusions:The CT radiomics prediction model effectively predicted the pathological response and prognosis of patients with LAGC after neoadjuvant immunotherapy combined with chemotherapy and is ex-pected to serve as a practical clinical tool.

Objective:To investigate the value of a computed tomography(CT)radiomics-based model for predicting the efficacy of neoad-juvant immunotherapy combined with chemotherapy for locally advanced gastric cancer(LAGC).Methods:Data on 114 patients with LAGC who underwent radical surgery after neoadjuvant immunotherapy combined with chemotherapy at The Second Affiliated Hospital of Xingtai Medical College between June 2019 and June 2021 were retrospectively collected.These patients'data were divided into a training set(n=67)and a validation set(n=47)based on the time of admission.High-throughput features were extracted from baseline portal phase CT images of all patients,and the selected features were used to construct the radiomics prediction model.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)and calibration curves.The prognostic ability of the model was assessed using Kaplan-Meier curves.Results:Based on the maximum relevancy min-redundancy(mRMR)algorithm and least absolute shrinkage and selection operator(LASSO)regression model,5 out of 584 assessed features were incorporated into the radiomics(Rad)score.The respect-ive areas under the curve for predicting pathological complete response(pCR)in the training and validation sets were 0.865 and 0.830,re-spectively,and good fits were obtained(Hosmer-Lemeshow test:P>0.05).The optimal cut-off value for the Rad score was determined based on the Youden index.Patients with high Rad scores had significantly higher 3-year recurrence-free survival rates(82.7%vs.60.4%in the training set and 78.9%vs.53.8%in the validation set)and 3-year overall survival rates(78.9%vs.60.2%in the training set and 79.3%vs.50.0%in the validation set)than those with low Rad scores(P<0.05).Conclusions:The CT radiomics prediction model effectively predicted the pathological response and prognosis of patients with LAGC after neoadjuvant immunotherapy combined with chemotherapy and is ex-pected to serve as a practical clinical tool.

Objective:To compare the efficacy of ultrasound volume navigation (UVN) and that of O-arm navigation in the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients with thoracolumbar vertebral fracture who had been treated with percutaneous pedicle screw fixation at Department Ⅰ of Minimally Invasive Spinal Surgery, Luoyang Orthopedic Hospital from January 2022 to June 2023. The patients were assigned into 2 groups according to different navigation methods. In group UVN of 17 cases, there were 14 males and 3 females with a mean age of 50.0 (44.0, 53.5) years, and the pedicle screw fixation was guided by UVN; in group O-arm of 12 cases, there were 10 males and 2 females with an age of (40.6±11.1) years, and the pedicle screw fixation was guided by O-arm navigation. The 2 groups were compared in terms of insertion time per screw, total dose of intraoperative radiation, radiation dose per screw, accuracy of screw placement, rate of facet joint violation, and visual analogue scale (VAS) pain scores for lumbar pain at postoperative 1, 3, and 6 months.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). There was no statistically significant difference in the insertion time per screw between group UVN and group O-arm [(13.2±1.3) min versus (14.1±1.3) min] ( P>0.05). The total dose of intraoperative radiation and radiation dose per screw in group UVN [(1.80±0.54) mSv and (0.41±0.10) mSv] were significantly lower than those in group O-arm [(3.52±0.33) mSv and (0.85±0.11) mSv] ( P<0.05). The accuracy of screw placement and rate of facet joint violation in group UVN [94.7% (71/75) and 17.6% (3/17)] were not significantly different from those in group O-arm [92.2% (47/51) and 8.3% (1/12)]] ( P>0.05). The VAS score at postoperative 1 month in group UVN [4.0 (3.5, 5.0) points] was significantly lower than that in group O-arm [5.0 (5.0, 6.0) points] ( P<0.05). There were no statistically significant differences between the 2 groups in the VAS pain scores at postoperative 3 and 6 months ( P>0.05). Conclusions:In the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation, screw placement guided by UVN is as time-saving, intuitive, and accurate as that guided by O-arm navigation. However, UVN is better than O-arm navigation in radiation avoidance and pain relief.

Objective:To compare the efficacy of ultrasound volume navigation (UVN) and that of O-arm navigation in the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients with thoracolumbar vertebral fracture who had been treated with percutaneous pedicle screw fixation at Department Ⅰ of Minimally Invasive Spinal Surgery, Luoyang Orthopedic Hospital from January 2022 to June 2023. The patients were assigned into 2 groups according to different navigation methods. In group UVN of 17 cases, there were 14 males and 3 females with a mean age of 50.0 (44.0, 53.5) years, and the pedicle screw fixation was guided by UVN; in group O-arm of 12 cases, there were 10 males and 2 females with an age of (40.6±11.1) years, and the pedicle screw fixation was guided by O-arm navigation. The 2 groups were compared in terms of insertion time per screw, total dose of intraoperative radiation, radiation dose per screw, accuracy of screw placement, rate of facet joint violation, and visual analogue scale (VAS) pain scores for lumbar pain at postoperative 1, 3, and 6 months.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). There was no statistically significant difference in the insertion time per screw between group UVN and group O-arm [(13.2±1.3) min versus (14.1±1.3) min] ( P>0.05). The total dose of intraoperative radiation and radiation dose per screw in group UVN [(1.80±0.54) mSv and (0.41±0.10) mSv] were significantly lower than those in group O-arm [(3.52±0.33) mSv and (0.85±0.11) mSv] ( P<0.05). The accuracy of screw placement and rate of facet joint violation in group UVN [94.7% (71/75) and 17.6% (3/17)] were not significantly different from those in group O-arm [92.2% (47/51) and 8.3% (1/12)]] ( P>0.05). The VAS score at postoperative 1 month in group UVN [4.0 (3.5, 5.0) points] was significantly lower than that in group O-arm [5.0 (5.0, 6.0) points] ( P<0.05). There were no statistically significant differences between the 2 groups in the VAS pain scores at postoperative 3 and 6 months ( P>0.05). Conclusions:In the treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation, screw placement guided by UVN is as time-saving, intuitive, and accurate as that guided by O-arm navigation. However, UVN is better than O-arm navigation in radiation avoidance and pain relief.

OBJECTIVE: To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. METHODS: Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T ₁₂ in 15 cases, L ₁ in 20 cases, L ₂ in 19 cases, and L ₃ in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. RESULTS: In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05). CONCLUSION UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
Male ; Female ; Humans ; Middle Aged ; Pedicle Screws ; Prospective Studies ; X-Rays ; Surgery, Computer-Assisted/methods* ; Spinal Fusion/methods* ; Fluoroscopy/methods* ; Lumbar Vertebrae/injuries*

OBJECTIVE: To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. METHODS: Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. RESULTS: The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697). CONCLUSION UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae/surgery* ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome