ObjectiveTo investigate the possible mechanism of Huatan Sanjie Formula （化痰散结方， HSF） in treating Graves' disease （GD） from the perspective of thyroid angiogenesis. MethodsThirty-six BALB/c female mice were randomly divided into a normal control group （n=9） and a modeling group （n=27）. Mice in the modeling group were injected with 2.0×10⁹ PFU/ml of Ad-TSHR289 adenovirus into the tibialis anterior muscle to build GD model. Nine weeks after immunization， the successfully modeled mice were randomly divided into model group， methimazole （MMI） group and HSF group， with 9 mice in each group. The MMI group was given 5.2 mg/（kg·d） of methimazole tablets by gavage， while the HSF group was given HSF at a relative crude drug dosage of 7.02 g/（kg·d） by gavage. The normal control group and the model group were given 0.1 ml/10 g of pure water by gavage. All groups were administered intragastrically once a day for a total of 4 weeks. The levels of thyroxine （T4） and thyrotropin receptor autoantibodies （TRAb） in serum were detected by radioimmunoassay， while the pathological changes of the thyroid gland were assessed by HE staining. The vascular morphology of thyroid tissue was observed by CD34 immunohistochemical staining， and the microvessel density （MVD） was counted. The protein expression of vascular endothelial growth factor A （VEGFA） and vascular endothelial growth factor receptor 2 （VEGFR2） in thyroid was detected by Western-blot. ResultsCompared to those in the normal control group， the thyroid volume of the mice in the model group significantly increased with excessive congestion， and the pathology showed significant thyroid follicular hyperplasia， columnar and proliferated epithelial cells， and enlarged follicle size； serum T4 and TRAb significantly increased， as well as the count of thyroid MVD， and the protein expressions of thyroid VEGFA and VEGFR2 （P＜0.01）. Compared to those in the model group， the thyroid glands of the mice in the MMI group and the HSF group were significantly reduced， and the congestion was improved； pathology showed that thyroid follicular hyperplasia and epithelial cell proliferation were reduced， with smooth edges of the follicles and the significantly reduced inward protrusion； serum T4 and TRAb significantly decreased， as well as the thyroid MVD， thyroid VEGFA and VEGFR2 protein expressions （P＜0.05 or P＜0.01）. There was no significant difference in all indicators between the MMI group and the HSF group （P＞0.05）. ConclusionHSF may inhibit thyroid angiogenesis by down-regulating thyroid VEGFA/VEGFR2 signaling pathway， thereby improving goitre and hyperfunction in GD mice.

In the past 20 years,the development of artificial intelligence has made rapid progress,and it is increasingly applied in the medical field,including medical image-assisted diagnosis and treatment,health management,disease risk prediction and so on.In this paper,the application status of artificial intelligence-assisted detection and diagnosis system based on deep learning in anorectal diseases is summarized,and the new methods related to the diagnosis and treatment of anorectal diseases at home and abroad are summarized.It mainly reviews the research progress of artificial intelligence technology in the diagnosis and treatment of anal fistula,perianal abscess,hemorrhoids and other anorectal diseases.

OBJECTIVE: To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures. METHODS: A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up. RESULTS: All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05). CONCLUSION Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.
Humans ; Fracture Fixation, Internal/methods* ; Retrospective Studies ; Imaging, Three-Dimensional ; Bone Screws ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Spinal Fractures/surgery* ; Fractures, Bone/surgery* ; Pelvic Bones/injuries* ; Postoperative Complications ; Neck Injuries

The adherence of inhalational drug administration is closely related the treatment effectiveness for patients with chronic respiratory diseases; on the other hand, poor adherence may increase healthcare costs or even lead to the death of patients. Electronic inhaler monitoring, currently considered the gold standard for assessing adherence, can provide clinicians with objectively accurate medication data, thereby assisting in clinical decision-making. This article provides a review of the significance of inhalation administration, the newly concept of medication adherence, the challenges faced in chronic respiratory diseases, and the current status of the application and value of electronic inhaler monitoring in improving adherence of inhalational drug administration for respiratory disease patients.

Objective:To evaluate the diagnostic efficacy of prostate imaging recurrence reporting (PI-RR) system for detecting local recurrence after radical prostatectomy (RP) in prostate cancer (PCa) and to assess the consistency of the PI-RR scores assigned by different seniority radiologists.Methods:This study was a cross-sectional study. A total of 176 PCa patients who underwent multi-parametric MRI (mpMRI) for biochemical recurrence (BCR) after RP from July 2015 to October 2021 at the First Affiliated Hospital of Soochow University were retrospectively collected. The mpMRI images were reviewed and the PI-RR scores of the main lesions were assigned independently by six different seniority radiologists (2 junior, 2 senior and 2 expert radiologists). Following the reference standard determined by biopsy pathologic results, follow-up imaging, or prostate specific antigen levels, the patients were divided into two groups: 54 patients with local recurrence and 122 patients without local recurrence. The intraclass correlation coefficient ( ICC) and Kappa test were used to evaluate the consistency of the PI-RR scores by different seniority radiologists. The receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic efficacy of the PI-RR scores assessed by different seniority radiologists for detecting local recurrence of PCa after RP. The DeLong test was utilized to compare the areas under the ROC curve (AUC) of different seniority radiologist PI-RR scores and a false discovery rate (FDR) was applied to correct results using the Benjamini and Hochberg method. Sensitivity and specificity were calculated according to the cutoff value of PI-RR score≥3 or 4. Results:The ICC (95% CI) of all different seniority radiologists was 0.70 (0.64-0.76). The Kappa value was 0.528, 0.325 and 0.370 respectively between expert and senior radiologists, expert and junior radiologists, senior and junior radiologists. The AUC (95% CI) of junior, senior, and expert radiologists were separately 0.73 (0.65-0.81), 0.81 (0.74-0.88), and 0.86 (0.80-0.93). The AUC of the expert radiologist PI-RR score was higher than those of senior and junior radiologist PI-RR scores ( Z=2.22, 3.21, FDR P=0.039, 0.003). The PI-RR score of senior radiologist had higher AUC than that of junior radiologist ( Z=2.22, FDR P=0.026). With the PI-RR score of 3 or greater as a cutoff value, the sensitivity of junior, senior and expert radiologists were respectively 0.59, 0.65, and 0.78 and the specificity were 0.82, 0.93, and 0.95. With the PI-RR score of 4 or greater as a cutoff value, the sensitivity of junior, senior and expert radiologists were respectively 0.50, 0.54, and 0.69 and the specificity were 0.88, 0.96 and 0.97. Conclusion:PI-RR score can accurately diagnose local recurrence of PCa after RP. PI-RR score has a moderate inter-reader consistency across different seniority radiologists. And the diagnostic performance is influenced by the experience of radiologists.

Objective:To explore the ventilation strategy of using pressure controlled ventilation-volume guaranteed (PCV-VG) mode combined with personalized positive end expiratory pressure (PEEP) during surgery, and its impact on oxygenation function and incidence of postoperative pulmonary complications (PPCs) in patients undergoing brain tumor surgery.Methods:Sixty patients who underwent elective brain tumor surgery at the Linyi People′s Hospital from January 2023 to June 2023 were selected. The patients were randomly divided into PCV-VG ventilation mode group (T group) and volume controlled ventilation (VCV) mode group (C group) using a random number table method, with 30 patients in each group. One patient was excluded from group T due to changes in the condition, and 29 patients were actually included. Group T adopted PCV-VG ventilation mode and searched for the maximum dynamic lung compliance (Cdyn) by titrating PEEP. The PEEP corresponding to the maximum Cdyn value was the optimal PEEP, which was maintained until the end of mechanical ventilation. Group C adopted a ventilation mode of VCV plus 5 cmH 2O fixed value PEEP. All patients underwent arterial blood gas analysis before anesthesia induction (T 1), 15 minutes after setting ventilation mode (T 2), and 15 minutes after extubation (T 3), recording arterial oxygen partial pressure (PaO 2), carbon dioxide partial pressure (PaCO 2), lactate (Lac), and blood glucose (Glu), and calculating oxygenation index (PaO 2/FiO 2). The levels of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were recorded before and 72 hours after surgery. The incidence of postoperative PPCs at 72 hours was observed. Results:There was a statistically significant difference in the grouping effect and time effect of PaO 2 and PaCO 2 between group C and group T (all P<0.05), while there was no statistically significant difference in the interaction effect (all P>0.05); The differences in grouping effects, time effects, and interaction effects of PaO 2/FiO 2 between group C and group T were statistically significant (all P<0.05); The average value of the optimized PEEP obtained by T-group titration was 7.48 cmH 2O, corresponding to an average platform pressure (Pplat) of 14.90 cmH 2O, and an average value of 53.37 ml/cmH 2O corresponding to the maximum Cdyn value. Compared with the Pplat and Cdyn corresponding to the fixed value of 5 cmH 2O PEEP in Group C, the Pplat corresponding to the optimized PEEP in Group T was lower than that in Group C ( P<0.05), and the Cdyn was higher than that in group C ( P<0.05). The CRP level and incidence of PPCs in group T after 72 hours of surgery were significantly lower than those in group C (all P<0.05). Conclusions:Compared with VCV, the ventilation mode of PCV-VG combined with personalized PEEP can improve intraoperative lung ventilation and oxygenation function in patients with brain tumors, reduce the occurrence of pulmonary inflammation 72 hours after surgery, and lower the incidence of PPCs.

Objective To explore the value of CT-derived fractional flow reserve(CT-FFR)and pericoronary fat attenuation index(FAI)combined with clinical and coronary CT angiography(CCTA)characteristics for predicting major adverse cardiovascular events(MACE)after aortic valve replacement(AVR).Methods Data of 139 patients with aortic stenosis who underwent AVR were retrospectively analyzed.According to occurrence of MACE or not during follow-up,the patients were divided into MACE group and non-MACE group.Cox proportional hazard regression was used to analyze clinical and CCTA data,as well as CT-FFR and FAI to screen independent predictors of MACE after AVR,and nested models based on clinical data,CCTA characteristics,CT-FFR and right coronary artery(RCA)FAI were constructed.Receiver operating characteristic(ROC)curves were drawn,the area under the curve(AUC)and Harrell C index(C-index)were calculated to assess the diagnostic efficacy of each model,and their goodness of fit were evaluated.Results There were 22 cases in MACE group and 117 in non-MACE group.CT-FFR(HR=3.683)and RCA-FAI(HR=3.261)were both independent predictors of MACE in patients after AVR.The AUC of clinical model,modelclinical+CCTA,modelclinical+CCTA+CT-FFR and modelclinical+CCTA+CT-FFR+RCA-FAI was 0.636,0.730,0.758 and 0.817,and the C-index was 0.614,0.707,0.733 and 0.782,respectively.The predicted results of modelclinical+CCTA+CT-FFR+RCA-FAI were most consistent with actual results,with the best goodness of fit.Conclusion CT-FFR and RCA-FAI combined with clinical and CCTA characteristics could effectively predict MACE in patients after AVR.

Objective:To investigate the protective effect of quercetin against LasB-induced apoptosis, inflammation, and oxidative stress in THP-1 macrophages, providing valuable insights into the use of quercetin as a virulence inhibitor for Pseudomonas aeruginosa infection treatment. Methods:This was an experimental study. The experimental strain was the standard strain. The LasB protein was obtained utilizing protein recombination technology, while the enzyme activity of LasB was assessed through both the Elastin Congo red assay and fluorescently labelled elastin assay. The LasB-induced THP-1 macrophage infection model was established, and quercetin was utilized for intervention. Cell viability was evaluated via CCK-8 assay, while cell morphology was observed under an inverted microscope. Apoptosis detection involved employing both TUNEL and Annexin V/PI staining. The mRNA expression and protein levels of inflammatory cytokines and COX-2 were determined by RT-qPCR and ELISA respectively. Intracellular ROS levels were quantified using the DCFH-DA fluorescent probe. One-way ANOVA was used for statistical analysis, and Tukey test was used for multiple comparisons. Results:The pLasB with a molecular weight of 33 000 and acceptable enzymatic activity (purity>90%), was successfully obtained. THP-1 macrophages treated with pLasB at a concentration of 100 μg/ml presented significantly decreased viability and integrity rate when compared with the normal control group. Additionally, pLasB promoted apoptosis, up-regulated the levels of inflammatory cytokines IL-1α, IL-1β, IL-6, IL-10, IL-12, and TNF-α, increased intracellular ROS fluorescence intensity, and elevated COX-2 mRNA expression level. Furthermore, the viability of THP-1 macrophages was significantly enhanced under quercetin intervention at concentrations of 2.5 μmol/L, 5 μmol/L and 10 μmol/L. The apoptosis rate exhibited a significant reduction from 18.32%±0.17% to 13.17%±0.20%, 11.43%±0.06% and 7.74%±0.04%, respectively ( F=1 679, P<0.05). There was a notable down-regulation of pro-inflammatory cytokines IL-1α, IL-1β, IL-6, IL-12 and TNF-α while the anti-inflammatory cytokine IL-10 showed a significant up-regulation. Both intracellular ROS fluorescence intensity ( F=86.92, P<0.05) and COX-2 level ( F=24.62, P<0.05) demonstrated a substantial decrease. Conclusion:Quercetin demonstrates significant efficacy in inhibiting LasB-induced apoptosis, inflammation, and oxidative stress in THP-1 macrophages, which highlights immense potential as a potent virulence inhibitor of Pseudomonas aeruginosa.

Objective To explore the value of coronary fat attenuation index(FAI)combined with laboratory indicators in predicting the risk of acute coronary syndrome(ACS)in patients with coronary heart disease(CHD).Methods A retrospective analysis was conducted on 454 patients who were diagnosed with CHD in Guangdong Provincial People's Hospital SCAD group(n=233)and an ACS group(n=221).Univariate and multivariate Logistic regression analyses were performed on the FAI values of the main coronary branches[right coronary artery(RCA),left anterior descending branch(LAD),left circumflex branch(LCX)],laboratory indicators,and clinical data,to identify independent risk factors for ACS in CHD patients.Receiver operating characteristic curves were constructed,and area under the curve(AUC)was calculated to evaluate the predictive performance of the independent risk factors and their combinations.Results LAD-FAI,RCA-FAI,and high-sensitivity C-reactive protein(hs-CRP)were independent influencing factors for ACS in CHD patients.The AUC for the prediction of ACS occurrence in CHD patients based on LAD-FAI,RCA-FAI,and elevated hs-CRP values alone were 0.568,0.703,and 0.749,respectively.When these three factors were analyzed in combination,the AUC was 0.815.Conclusion The combined analysis of LAD-FAI,RCA-FAI,and hs-CRP has good predictive performance for assessing the risk of ACS in CHD patients.

Objective To explore the efficacy of thoracic endovascular aortic repair(TEVAR)for the treatment of Stanford type B aortic dissection at different intervention timing.Methods The clinical data of 126 patients with Stanford B type aortic dissection,who were admitted to authors'hospital between January 2018 and April 2023,were retrospectively analyzed.Based on the time interval from the onset of disease to receiving surgery,the patients were divided into group A(＜24 h),group B(2-7 d)and group C(8-14 d).The incidences of perioperative adverse events,including endoleak,cerebral infarction,death,aortic rupture and total complications,were compared between each other among the three groups,and survival analysis was performed according to the follow-up findings.Results A total of 126 patients with Stanford type B aortic dissection were included in this study,including 50 patients of group A,43 patients of group B,and 33 patients of group C.No statistically significant differences in the general clinical data existed between each other among the three groups(P＞0.05).The differences in the incidences of perioperative acute cerebral infarction,endoleak,infection and death between each other among the three groups were not statistically significant(P＞0.05).The difference in the overall complication rate between each other among the three groups was statistically significant(P＜0.05).Log-rank testing was used to compare the survival curves of the three groups,which showed that the cumulative 5-year recurrence rate and survival rate in group A were lower than those in group B and in group C,and the differences were statistically significant(P＜0.05).Conclusion The results of this study indicate that the patients may have high incidence of adverse events and poor short-to-middle-term curative efficacy when TEVAR is performed within 24 hours after the onset of symptoms,while the patients may have better perioperative and short-to-middle-term curative efficacy if TEVAR is carried out in 2-14 days after the onset of symptoms(J Intervent Radiol,2024,33:523-528)