Objective To construct a preoperative prediction model for proliferative hepatocellular carcinoma(HCC)based on enhanced CT image features,and to analyze the prognosis of the disease.Methods A retrospective case-control study was conducted on 603 patients with pathologically confirmed HCC.Among them,519 cases from the First Affiliated Hospital of Army Medical University were randomly divided into a training group(n=363)and an internal verification group(n=156)in a ratio of 7:3.Another 84 patients from the Second Affiliated Hospital of Chongqing Medical University served as an external validation group.All patients underwent abdominal CT scan with contrast before surgery.The clinical data and CT imaging characteristics of proliferative and non-proliferative HCC patients were observed.Binary logistic regression analysis was used to identify the independent risk factors of proliferative HCC,and a nomogram prediction model was constructed.Receiver operating characteristic(ROC)curve was plotted to evaluate its diagnostic performance,and calibration curve and decision curve analysis(DCA)were applied to evaluate its calibration performance and clinical application value.The model was validated in both the internal and external validation groups.Kaplan-Meier survival curves were employed to compare the prognosis between proliferative and non-proliferative HCC.Results Multivariate analysis showed that negative result of HBV-DNA quantification,incomplete tumor capsule,intratumoral necrosis or ischemia(≥20%),and annular hyperenhancement in arterial phase were independent predictors in predicting proliferative HCC(P<0.05).Our nomogram model for predicting proliferative HCC based on the above clinical imaging features had an AUC value of 0.805(95%CI:0.756～0.854),a sensitivity of 83.19%and a specificity of 64.80%in the training group.For the internal validation group,the AUC value was 0.793(95%CI:0.721～0.854),the sensitivity was 67.86%,and the specificity was 75.00%.In the external validation group,the AUC value was 0.842(95%CI:0.746～0.912),the sensitivity was 72.41%,and the specificity was 90.91%.Calibration curve and DCA showed that the model had good calibration performance and clinical applicability.The disease free survival(DFS)of the patients with proliferative HCC diagnosed by pathologically confirmed/predictive models was significantly shorter than that of non-proliferative HCC patients(training group:P=0.005,P<0.001;internal validation group:P=0.006,P=0.006;external validation group:P=0.002,P=0.015).Conclusion Our prediction model based on clinical and imaging features can accurately diagnose proliferative HCC before surgery,and the prognosis of proliferative HCC is generally poor.

Objective:To investigate the changes in spinal cord blood flow (SCBF) caused by spinal osteotomy shortening and its impact on spinal cord function, thereby determining a safe range for osteotomy shortening.Methods:Fifteen healthy male rabbits were randomly divided into three groups: the control group (spinal osteotomy with dura mater exposure only), the shortening 1/3 group (spinal shortening by one-third with dura mater exposure), and the shortening 1/2 group (spinal shortening by one-half with dura mater exposure), with five rabbits in each group. A laser speckle imaging system was used to monitor SCBF and spinal vascular diameter throughout the spinal osteotomy and shortening procedures. SCBF and vascular diameter were recorded postoperatively. Spinal cord function was assessed using intraoperative electrophysiological monitoring, and sensory and motor functions were evaluated using the Reuters score before and after surgery.Results:No abnormalities were detected in the electrophysiological monitoring of any group during the experiment. Laser speckle imaging revealed that, compared to pre-osteotomy levels, some branch vessels began to fade significantly when spinal shortening reached 1/3, and some small branch vessels disappeared in imaging at 1/2 shortening. The postoperative SCBF values for the control, shortening 1/3, and shortening 1/2 groups were 229.71±139.00 PU, 296.84±118.21 PU, and 168.06±76.57 PU, respectively, with significant differences ( F=43.820, P<0.001). The postoperative spinal vascular diameters were 215.39±118.23 μm, 276.47±96.00 μm, and 350.77±90.97 μm, respectively, also showing significant differences ( F=32.150, P<0.001). Postoperative Reuters scores were 1.20±0.45, 2.40±0.55, and 4.00±0.71 for the control, shortening 1/3, and shortening 1/2 groups, respectively, with significant differences ( F=29.600, P<0.001). The shortening 1/2 group had significantly higher scores than both the control and shortening 1/3 groups ( P<0.05). A positive correlation was observed between SCBF and spinal cord blood vessel diameter from pre-osteotomy to 1/3 shortening ( r=0.661, P=0.037). However, SCBF negatively correlated with postoperative Reuters scores from 1/3 to 1/2 shortening ( r=-0.830, P=0.003), whereas spinal cord blood vessel diameter showed a positive correlation with postoperative Reuters scores ( r=0.537, P=0.039). Conclusions:As the degree of spinal shortening increases, the diameter of spinal cord blood vessels gradually expands, while SCBF initially rises and then declines. A positive correlation exists between vascular diameter and SCBF at shortening ratios of <1/3, whereas a negative correlation is observed between SCBF and postoperative Reuters scores at shortening ratios between 1/3 and 1/2. Additionally, vascular diameter correlates positively with postoperative Reuters scores from pre-osteotomy to 1/2 shortening. These findings suggest that spinal cord function can be effectively preserved when spinal shortening does not exceed 1/2.

BACKGROUND:Adolescent idiopathic scoliosis is a common spinal deformity that seriously affects the physical and mental health of patients.Modal analysis will focus on analyzing the natural vibration characteristics of the thoracic spine and its stability and response under the influence of external vibration.This analysis is expected to not only enhance the understanding of the thoracic curvature of adolescent idiopathic scoliosis,but also provide new perspectives and methods for developing new treatment strategies,designing personalized braces,and evaluating surgical outcomes.OBJECTIVE:To create a three-dimensional finite element model to evaluate the response modes of the entire thoracic spine and intervertebral discs in adolescent idiopathic scoliosis patients at different vibration frequencies,and determine the potential frequency range of injury risk.METHODS:This study was jointly conducted at the Sixth Affiliated Hospital of Xinjiang Medical University and the School of Mechanical Engineering at the Boda Campus of Xinjiang University from June 2023 to June 2024.The research subject was a patient with severe spinal and thoracic curvature.CT images were obtained using Siemens dual source spiral CT scanning,and a fine T1-T12 three-dimensional finite element model was established using software such as Mimics,Geomagic Studio,Solidworks,and Hypermesh.Abaqus software was used to perform modal analysis on the model and obtain the maximum amplitude and corresponding vibration modes of the first 12 modes of the entire thoracic spine and intervertebral disc.RESULTS AND CONCLUSION:(1)The modal analysis results showed that the entire thoracic vertebrae and intervertebral discs mainly bent and twisted around the X and Y axes in the lower order modes,while increasing rotation around the Z axis in the higher order modes.(2)The T1-T3 and T6-T8 segments showed the most significant deformation and higher load burden,indicating that these regions played a crucial role in the development of scoliosis.(3)When the natural frequency was concentrated between 98.832 to 121.97 cycles/s for a long time,the vibration displacement of the entire thoracic vertebrae and intervertebral discs was large,which might lead to spinal injury.(4)Through finite element modal analysis,this study provides a scientific basis for understanding the response of the entire thoracic spine and intervertebral discs in adolescent idiopathic scoliosis patients under various vibration frequencies,thereby offering crucial insights into clinical treatment,prevention,and particularly,vibration-related protective strategies.Furthermore,by identifying the potential frequency range of injury risk,this study provides an important basis for developing vibration protection measures and optimizing spinal care strategies for adolescent idiopathic scoliosis patients.

Objective:To explore whether gait training facilitated by an intelligent lower limb rehabilitation robot can en-hance the walking capabilities of post-stroke patients with hemineglect.Method:A total of forty patients,who had suffered from hemilateral neglect post-stroke,were randomly as-signed to either a control group or an experimental group,with twenty individuals in each.All patients re-ceived conventional pharmacotherapy,repetitive transcranial magnetic stimulation(rTMS),and standard rehabili-tation training.Additionally,the experimental group underwent robot-assisted gait training,whereas the control group was engaged in traditional walking training.Parameters such as hemineglect symptom scores,Fugl-Mey-er assessment for lower extremity(FMA-LE)scores,and various gait metrics(including stride speed,stride length time,stride frequency,stride length time disparity,and impact difference)were evaluated and com-pared between both groups pre-and post-treatment.Result:Initially,no significant disparities were observed in the baseline data of the two groups(all P>0.05).Subsequently,improvements in line segmentation,line bisecting,and star cancellation test scores were noted in both groups post-treatment(all P<0.05).Moreover,the post-treatment FMA-LE scores exhibited a signifi-cant enhancement compared to the pre-treatment scores(all P<0.01),with the experimental group demonstrat-ing a more pronounced improvement(P<0.01).Furthermore,post-treatment assessments indicated notable ad-vancements in walking speed,stride length time,stride frequency,stride length time variance,and impact dif-ference in both groups(all P<0.01),with the experimental group showing superior progress(P<0.01).Conclusion:The findings suggest that gait training using an intelligent lower limb rehabilitation robot not only ameliorates hemineglect symptoms but also significantly improves the walking abilities of stroke patients afflict-ed with hemineglect.

Objective To explore the efficacy and safety of side-to-side anastomosis(SS)and end-to-side anastomosis(ES)of the ileocolon in laparoscopic right hemicolectomy of colon cancer,so as to provide evidence-based evidence for surgical selection.Methods PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP database,Chinese BioMedical Literature database were searched from inception to November 2024 to collect relevant clinical studies of SS versus ES.The Newcastle-Ottawa Scale(NOS)was used to evaluate the literature quality of retrospective studies,and the Cochrane system was used to evaluate the literature quality of randomized controlled trials(RCT).Rev Man 5.3 software was used for Meta-analysis,sensitivity analysis,and publication bias analysis.Results 9 retrospective studies and 4 RCTs with a total of 2 632 patients were included.The Meta-analysis results of the retrospective study show that:Compared with SS,ES has a shorter tolerance time for liquid diet(MD=-0.20,95%CI:-0.40～0.00,P<0.05),fewer daily episodes of diarrhea(MD=-1.06,95%CI:-1.79～0.23,P<0.05),but a higher pain score at 12 hours post-surgery(MD=0.95,95%CI:0.50～1.40,P<0.05).Comparison of the overall complication rates of the two anastomosis methods showed no statistically significant difference((OR)=1.05,95%CI:0.22～5.14,P>0.05).Sensitivity analysis of the retrospective study shows:the incidence of ES bowel obstruction was higher than that of SS,with a statistically significant difference((OR)=2.18,95%CI:1.15～4.14,P<0.05);The sensitivity analysis of the RCT shows:the overall incidence of complications at the anastomotic site of SS was significantly higher than that of ES,with a statistically significant difference((OR)=5.26,95%CI:1.91～14.48,P<0.05),and the results of other outcome indicators did not show reversal.The analysis of publication bias risk showed no significant publication bias.Conclusion Ileocolonic ES has a slight advantage over SS in laparoscopic right hemicolectomy of colon cancer,both anastomoses are safe and effective,and the surgeon can choose the appropriate anastomosis technique according to the patient's specific situation,in order to improve the postoperative recovery.

Objectives:To systematically evaluate the effects of spinal osteotomy and spinal cord blood flow(SCBF)on the spinal cord,and to explore the safe range of osteotomy.Methods:The relevant research liter-atures on spinal osteotomy shortening and SCBF in CNKI,Wanfang,VIP,PubMed,Cochrane Library,EM-BASE and CBM databases published before May 2024 were searched by computer.Two researchers indepen-dently conducted literature screening and extracted data(research design,sample size,and outcome indicators).The quality of the included literatures was evaluated by using the improved Jadad score scale and Newcastle-Ottawa scale(NOS)score.The Revman 5.3 software was used for meta-analysis.Results:A total of 8 litera-tures were included,and the risk of the included literatures mainly came from the allocation hiding and out-come blind methods after evaluated with the Cochrane risk bias assessment tool;The Jadad scale scores of the 6 randomized controlled studies and the NOS scores of the 2 cohort studies were all ≥ 5.A total of 170 subjects were included,including 91 dogs,50 rabbits,and 29 clinical patients;In the animal experiments of dogs,the SCBF increased when the spinal vertebrae were shortened by 2/4 compared with 1/3 or 1/4[OR=-24.10,95％CI(-35.96,-12.23),Z=3.98,P＜0.0001];The SCBF in dogs decreased when the spinal vertebrae were shortened by 2/3 or 3/4 compared with 2/4[OR=44.63,95％CI(19.16,70.09),Z=3.43,P=0.0006];Spinal cord evoked potentials(SCEP)was significantly abnormal when spinal vertebrae shortening was 2/3 or 3/4 compared with 1/3 or 1/4[OR=0.03,95％CI(0.00,0.21),Z=3.55,P=0.004];The dural sac tortuous angle in-creased significantly when the spinal vertebrae shortening in rabbits was more than 2/4[OR=53.51,95％CI(17.92,89.10),Z=2.95,P=0.003],which led to a sharp decrease in SCBF,and the difference was statistically significant.In clinical studies,the SCBF after spinal vertebrae shortening of less than 2/4,that was,about 2/4 of the resection space,was slightly higher than that after vertebral column resection(VCR)[OR=43.81,95％CI(20.40,67.21),Z=3.67,P=0.002],and the difference was statistically significant.Conclusions:In animal ex-periments in dogs and rabbits and clinical studies,spinal vertebrae shortening of less than 2/4 is the safe range of osteotomy;In the animal experiment of dogs,when the shortening is more than 2/3 or 3/4,it will lead to a sharp decrease in SCBF and cause obvious SCEP abnormalities.

Objective:To investigate the changes in spinal cord blood flow (SCBF) caused by spinal osteotomy shortening and its impact on spinal cord function, thereby determining a safe range for osteotomy shortening.Methods:Fifteen healthy male rabbits were randomly divided into three groups: the control group (spinal osteotomy with dura mater exposure only), the shortening 1/3 group (spinal shortening by one-third with dura mater exposure), and the shortening 1/2 group (spinal shortening by one-half with dura mater exposure), with five rabbits in each group. A laser speckle imaging system was used to monitor SCBF and spinal vascular diameter throughout the spinal osteotomy and shortening procedures. SCBF and vascular diameter were recorded postoperatively. Spinal cord function was assessed using intraoperative electrophysiological monitoring, and sensory and motor functions were evaluated using the Reuters score before and after surgery.Results:No abnormalities were detected in the electrophysiological monitoring of any group during the experiment. Laser speckle imaging revealed that, compared to pre-osteotomy levels, some branch vessels began to fade significantly when spinal shortening reached 1/3, and some small branch vessels disappeared in imaging at 1/2 shortening. The postoperative SCBF values for the control, shortening 1/3, and shortening 1/2 groups were 229.71±139.00 PU, 296.84±118.21 PU, and 168.06±76.57 PU, respectively, with significant differences ( F=43.820, P<0.001). The postoperative spinal vascular diameters were 215.39±118.23 μm, 276.47±96.00 μm, and 350.77±90.97 μm, respectively, also showing significant differences ( F=32.150, P<0.001). Postoperative Reuters scores were 1.20±0.45, 2.40±0.55, and 4.00±0.71 for the control, shortening 1/3, and shortening 1/2 groups, respectively, with significant differences ( F=29.600, P<0.001). The shortening 1/2 group had significantly higher scores than both the control and shortening 1/3 groups ( P<0.05). A positive correlation was observed between SCBF and spinal cord blood vessel diameter from pre-osteotomy to 1/3 shortening ( r=0.661, P=0.037). However, SCBF negatively correlated with postoperative Reuters scores from 1/3 to 1/2 shortening ( r=-0.830, P=0.003), whereas spinal cord blood vessel diameter showed a positive correlation with postoperative Reuters scores ( r=0.537, P=0.039). Conclusions:As the degree of spinal shortening increases, the diameter of spinal cord blood vessels gradually expands, while SCBF initially rises and then declines. A positive correlation exists between vascular diameter and SCBF at shortening ratios of <1/3, whereas a negative correlation is observed between SCBF and postoperative Reuters scores at shortening ratios between 1/3 and 1/2. Additionally, vascular diameter correlates positively with postoperative Reuters scores from pre-osteotomy to 1/2 shortening. These findings suggest that spinal cord function can be effectively preserved when spinal shortening does not exceed 1/2.

Objective To explore the efficacy and safety of side-to-side anastomosis(SS)and end-to-side anastomosis(ES)of the ileocolon in laparoscopic right hemicolectomy of colon cancer,so as to provide evidence-based evidence for surgical selection.Methods PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP database,Chinese BioMedical Literature database were searched from inception to November 2024 to collect relevant clinical studies of SS versus ES.The Newcastle-Ottawa Scale(NOS)was used to evaluate the literature quality of retrospective studies,and the Cochrane system was used to evaluate the literature quality of randomized controlled trials(RCT).Rev Man 5.3 software was used for Meta-analysis,sensitivity analysis,and publication bias analysis.Results 9 retrospective studies and 4 RCTs with a total of 2 632 patients were included.The Meta-analysis results of the retrospective study show that:Compared with SS,ES has a shorter tolerance time for liquid diet(MD=-0.20,95%CI:-0.40～0.00,P<0.05),fewer daily episodes of diarrhea(MD=-1.06,95%CI:-1.79～0.23,P<0.05),but a higher pain score at 12 hours post-surgery(MD=0.95,95%CI:0.50～1.40,P<0.05).Comparison of the overall complication rates of the two anastomosis methods showed no statistically significant difference((OR)=1.05,95%CI:0.22～5.14,P>0.05).Sensitivity analysis of the retrospective study shows:the incidence of ES bowel obstruction was higher than that of SS,with a statistically significant difference((OR)=2.18,95%CI:1.15～4.14,P<0.05);The sensitivity analysis of the RCT shows:the overall incidence of complications at the anastomotic site of SS was significantly higher than that of ES,with a statistically significant difference((OR)=5.26,95%CI:1.91～14.48,P<0.05),and the results of other outcome indicators did not show reversal.The analysis of publication bias risk showed no significant publication bias.Conclusion Ileocolonic ES has a slight advantage over SS in laparoscopic right hemicolectomy of colon cancer,both anastomoses are safe and effective,and the surgeon can choose the appropriate anastomosis technique according to the patient's specific situation,in order to improve the postoperative recovery.

Objectives:To systematically evaluate the effects of spinal osteotomy and spinal cord blood flow(SCBF)on the spinal cord,and to explore the safe range of osteotomy.Methods:The relevant research liter-atures on spinal osteotomy shortening and SCBF in CNKI,Wanfang,VIP,PubMed,Cochrane Library,EM-BASE and CBM databases published before May 2024 were searched by computer.Two researchers indepen-dently conducted literature screening and extracted data(research design,sample size,and outcome indicators).The quality of the included literatures was evaluated by using the improved Jadad score scale and Newcastle-Ottawa scale(NOS)score.The Revman 5.3 software was used for meta-analysis.Results:A total of 8 litera-tures were included,and the risk of the included literatures mainly came from the allocation hiding and out-come blind methods after evaluated with the Cochrane risk bias assessment tool;The Jadad scale scores of the 6 randomized controlled studies and the NOS scores of the 2 cohort studies were all ≥ 5.A total of 170 subjects were included,including 91 dogs,50 rabbits,and 29 clinical patients;In the animal experiments of dogs,the SCBF increased when the spinal vertebrae were shortened by 2/4 compared with 1/3 or 1/4[OR=-24.10,95％CI(-35.96,-12.23),Z=3.98,P＜0.0001];The SCBF in dogs decreased when the spinal vertebrae were shortened by 2/3 or 3/4 compared with 2/4[OR=44.63,95％CI(19.16,70.09),Z=3.43,P=0.0006];Spinal cord evoked potentials(SCEP)was significantly abnormal when spinal vertebrae shortening was 2/3 or 3/4 compared with 1/3 or 1/4[OR=0.03,95％CI(0.00,0.21),Z=3.55,P=0.004];The dural sac tortuous angle in-creased significantly when the spinal vertebrae shortening in rabbits was more than 2/4[OR=53.51,95％CI(17.92,89.10),Z=2.95,P=0.003],which led to a sharp decrease in SCBF,and the difference was statistically significant.In clinical studies,the SCBF after spinal vertebrae shortening of less than 2/4,that was,about 2/4 of the resection space,was slightly higher than that after vertebral column resection(VCR)[OR=43.81,95％CI(20.40,67.21),Z=3.67,P=0.002],and the difference was statistically significant.Conclusions:In animal ex-periments in dogs and rabbits and clinical studies,spinal vertebrae shortening of less than 2/4 is the safe range of osteotomy;In the animal experiment of dogs,when the shortening is more than 2/3 or 3/4,it will lead to a sharp decrease in SCBF and cause obvious SCEP abnormalities.

OBJECTIVE To establish the HPLC fingerprint of Xintong granules and the quantitative analysis of multi-components by single-marker method(QAMS)to determine the contents of 7 components,so as to provide a scientific basis for their quality control.METHODS HPLC method was used to establish the fingerprints for 10 batches of Xintong granules(No.S1-S10),and similarity evaluation,cluster analysis(CA)and partial least squares-discriminant analysis(PLS-DA)were performed.At the same time,the contents of seven components,including puerarin,daidzin,calycosin-7-O-β-D-glucoside,stilbene glycoside,naringin,icariin and tanshinone ⅡA,were determined by QAMS method,and were compared with the results of external standard method.RESULTS A total of 18 common peaks were marked and 7 peaks were identified in the HPLC fingerprints for 10 batches of Xintong granules,namely puerarin(peak 4),daidzin(peak 7),calycosin-7-O-β-D-glucoside(peak 9),stilbene glycoside(peak 10),naringin(peak 12),icariin(peak 17),and tanshinone ⅡA(peak 18);the similarities among them were more than 0.990,and CA and PLS-DA results showed that S4-S5,S8-S10,S1-S3 and S6-S7 were clustered into three categories,respectively.Using naringin as the internal standard,the contents of puerarin,daidzin,calycosin-7-O-β-D-glucoside,stilbene glycoside,icariin and tanshinone ⅡA were determined to be 7.868 1-10.181 2,1.709 2-2.374 1,0.285 2-0.326 3,1.024 1-1.523 9,0.140 2-0.290 4,and 0.077 1-0.219 4 mg/g,respectively,by the QAMS.These results showed no significant differences compared to those obtained by the external standard method.CONCLUSIONS Established HPLC fingerprint and QAMS method are convenient,stable and accurate,which can provide a basis for the quality evaluation of Xintong granules.