ObjectiveTo establish a risk recognition model for coronary artery stenosis by using a machine learning method and to identify the key causative factors. MethodsPatients aged ≥18 years，diagnosed with coronary heart disease through coronary angiography from January 2013 to May 2020 in two prominent hospitals in Shanxi Province， were continuously enrolled. Logistic regression，back propagation neural network （BPNN）， and random forest（RF）algorithms were used to construct models for detecting the causative factors of coronary artery stenosis. Sensitivity （TPR）， specificity （TNR）， accuracy （ACC）， positive predictive value （PV+）， negative predictive value （PV-）， area under subject operating characteristic curve （AUC）， and calibration curve were used to compare the discrimination and calibration performance of the models. The best model was then employed to predict the main risk variables associated with coronary stenosis. ResultsThe RF model exhibited superior comprehensive performance compared to logistic regression and BPNN models. The TPR values for logistic regression，BPNN，and RF models were 75.76%， 74.30%， and 93.70%， while ACC values were 74.05%， 72.30%， and 79.49%， respectively. The AUC values were：logistic regression 0.739 9； BPNN 0.723 1； RF 0.752 2. Manifestations such as chest pains，abnormal ST segments on ECG，ventricular premature beats with hypertension， atrial fibrillation， regional wall motion abnormalities（RWMA） by color echocardiography， aortic regurgitation（AR）， pulmonary insufficiency （PI）， family history of cardiovascular diseases，and body mass index（BMI）were identified as top ten important variables affecting coronary stenosis according to the RF model. ConclusionsRandom forest model shows the best comprehensive performance in identification and accurate assessment of coronary artery stenosis. The prediction of risk factors affecting coronary artery stenosis can provide a scientific basis for clinical intervention and help to formulate further diagnosis and treatment strategies so as to delay the disease progression.

Objective: To explore the learning curve of transurethral 450 nm blue light vaporization of the prostate (TUBVP) in a district hospital，in order to provide reference for clinicians who plan to perform TUBVP. Methods: The clinical data of 56 patients with benign prostatic hyperplasia (BPH) who received TUBVP performed by the same group of surgeons in Chang'an District Hospital during Jun. and Dec. 2023 were retrospectively analyzed. Cumulative sum (CUSUM) was used to fit the learning curve of ratio of volume to operating time (RVOT) of prostate volume /450 nm blue light. The learning curve was divided into different stages according to the inflection points，and the clinical data of patients operated at different stages were analyzed and compared. Results: The learning curve of TUBVP was 21 cases，including 1-21 cases in the learning stage，22-38 cases in the improvement stage and 39-56 cases in the maturity stage. With the increase of cases，the postoperative bladder irrigation time reduced \[40.00 (26.00，44.50) h vs. 23.00(20.50，34.00) h vs. 23.50(14.75，40.75) h\]，with statistical difference (P<0.05). The surgical efficiency increased \[(0.51±0.14) vs. (0.55±0.17) vs. (0.63±0.23)\]，while the reduction of hemoglobin \[(6.43±7.35) g/L vs. (5.65±10.91) g/L vs. (2.61±7.36) g/L\]，catheter indwelling time \[70.0 (66.0，106.0) h vs. 71.0 (66.0，89.0) h vs. 66.0 (58.5，78.5) h\]，and incidence of complications (9.5% vs. 5.9% vs. 0) in the three stages showed a gradually decreasing trend，but with no statistical significance (P>0.05). Conclusion: The learning curve of TUBVP is 21 cases. For clinicians in district hospitals，TUBVP is a worthy choice.

Objective To investigate the impact of COVID-19 infection on the early clinical outcomes of patients undergoing valve replacement. Methods Perioperative data of patients who underwent single valve replacement at the Second Affiliated Hospital of Chinese People's Liberation Army Medical University from January to February 2023 were consecutively collected. Based on COVID-19 infection status, patients were divided into a COVID-19 group and a non-COVID-19 group. The perioperative data were compared between the two groups. Results A total of 136 patients were included, comprising 53 males and 83 females, with a mean age of (53.4±10.2) years. There were 32 patients receiving aortic valve replacements, 102 mitral valve replacements, and 2 tricuspid valve replacements. The COVID-19 group comprised 70 patients, and the non-COVID-19 group included 66 patients. No statistical difference was observed in the incidence of postoperative complications between the two groups [9.09% (6/66) vs. 11.43% (8/70), P=0.654]. However, the COVID-19 group had longer postoperative mechanical ventilation duration [1 201.00 (1 003.75, 1 347.75) min vs. 913.50 (465.50, 1 251.00) min, P=0.001] and ICU stay [3 (2, 3) days vs. 2 (2, 3) days, P<0.001] compared to the non-COVID-19 group. Additionally, troponin I [4.76 (2.55, 7.93) ng/mL vs. 2.66 (1.19, 5.65) ng/mL, P=0.001] and brain natriuretic peptide [608.50 (249.75, 1 150.00) pg/mL vs. 192.00 (100.93, 314.75) pg/mL, P<0.001] levels were significantly higher in the COVID-19 group. Conclusion For patients with single valve disease undergoing elective surgery, short-term outcomes after recovery from COVID-19 infection are favorable, with no significant increase in in-hospital mortality or postoperative complication rates.

Acute lung injury (ALI) has been a kind of acute and severe disease that is mainly characterized by systemic uncontrolled inflammatory response to the production of huge amounts of reactive oxygen species (ROS) in the lung tissue. Given the critical role of ROS in ALI, a Fe₃O₄ loaded bovine serum albumin (BSA) nanocluster (BF) was developed to act as a nanomedicine for the treatment of ALI. Combining with NIR irradiation, it exhibited excellent ROS scavenging capacity. Significantly, it also displayed the excellent antioxidant and anti-inflammatory functions for lipopolysaccharides (LPS) induced macrophages (RAW264.7), and Sprague Dawley rats via lowering intracellular ROS levels, reducing inflammatory factors expression levels, inducing macrophage M2 polarization, inhibiting NF-κB signaling pathway, increasing CD4⁺/CD8⁺ T cell ratios, as well as upregulating HSP70 and CD31 expression levels to reprogram redox homeostasis, reduce systemic inflammation, activate immunoregulation, and accelerate lung tissue repair, finally achieving the synergistic enhancement of ALI immunotherapy. It finally provides an effective therapeutic strategy of BF + NIR for the management of inflammation related diseases.

Objective To investigate the correlation between non-alcoholic fatty liver disease(NAFLD)and coronary artery plaque and perivascular adipose tissue(PVAT)parameters.Methods A total of 119 patients who underwent liver ultrasound and coronary computed tomography angiography(CCTA)examination were selected and divided into NAFLD group(50 cases)and non-NAFLD group(69 cases).The types of coronary artery plaque,plaque vulnerability,plaque involvement length,plaque load,vascular remode-ling,degree of vessel stenosis,and parameters of pericoronary fat[pericoronary fat attenuation index(pFAI),pericoronary fat total volume of voxels(pFV),perivascular water attenuation index(PVWI)]were evaluated.The data were analyzed statistically.Results The incidence of vulnerable plaque in NAFLD group was higher than that in non-NAFLD group,and the difference was statistically significant(P＜0.001).The incidence of positive vascular remodeling in NAFLD group was higher than that in non-NAFLD group,the incidence of no remodeling was the opposite,and the differences were statistically significant(P=0.001).The incidence of non-calcified plaque in NAFLD group was higher than that in non-NAFLD group,and the incidence of calcified plaque was the opposite(P=0.011).The incidence of severe stenosis in NAFLD group was higher than that in non-NAFLD group,and the incidence of moderate stenosis was the opposite,with statistical significance(P=0.004).The pFAI and plaque load in NAFLD group was higher than that in non-NAFLD group,and the pFV value was lower than that in non-NAFLD group,with statistical significance(P＜0.001,P=0.029,P=0.002).Conclusion The incidences of vulnerable plaque,positive remodeling,non-calcified plaque,vascular severe stenosis,and plaque load are significantly higher in NAFLD group than those in non-NAFLD group.In addition,pFAI increases and pFV decreases in NAFLD group.

BACKGROUND:As a leading technique in the treatment of primary stenosis by posterior spinal endoscopy through unilateral approach and bilateral decompression using single channel endoscopy,the long-term efficacy needs to be further observed.There are few reports on the scope of intraoperative resection and few relevant studies on biomechanics and finite element analysis. OBJECTIVE:A three-dimensional finite element model was established to evaluate the effects of bilateral lumbar canal decompression under a one-hole split endoscope on lumbar range of motion and intradiscal pressure,to provide suggestions for clinical operation and theoretical basis for further clinical research. METHODS:A complete L3-L5 vertebral body model was reconstructed by CT images of nine healthy volunteers,which was used as the preoperative model M1.The simulated surgical resection range of L4-L5 was performed,and 1/4,1/3 and 1/2 of bilateral facet joints were removed respectively to obtain models M2,M3 and M4.The range of motion and the maximum Von Mises stress of the four models were compared in the six directions of forward bending,backward extension,left and right bending,and left and right rotation. RESULTS AND CONCLUSION:(1)The L3-L5 finite element model established in this study was effective,and the range of motion was within the range of previous solid studies under six motion states.(2)Compared with the M1 model,the L4-L5 lumbar spine range of motion increased with the increase of resection range in M2 with M3 and M4 models under forward bending,left and right bending and left and right rotation loading,and the difference was significant(P＜0.05).Under posterior extension loading,there was no significant difference in lumbar range of motion between M1 and M2(P＞0.05),but there was a significant difference of M1,M3 and M4(P＜0.05).(3)The range of motion of the L3-L4 lumbar spine had no significant change with the increase of bilateral facet arthrotomy(P＞0.05).(4)There was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M2(P＜0.05),and there was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M3,M4(P＜0.01),and the maximum value of L4-L5 lumbar von Mises increased with the increasing range of bilateral facet joint resection.Resection of more than 1/3 was particularly obvious.(5)The maximum value of Von Mises in the L3-L4 lumbar spine was increased with the increase of the resection range under forward bending,left and right bending and left and right rotation loading and the difference was significant(P＜0.05).(6)The results exhibited that the L4-L5 lumbar motion and intervertebral disc pressure increased with the increase of the excision range.Intervertebral disc pressure at L3-L4 increased with the increased extent of excision,but the lumbar range of motion was not significantly affected.In conclusion,the stability of the operative segment may be affected by the increase in the scope of facet joint resection.Although the immediate stability of adjacent segments is not affected,it may accelerate disc degeneration.

【Objective】 To investigate the application value of 450 nm blue laser vaporization in the treatment of benign prostatic hyperplasia (BPH) in district hospitals, so as to provide reference for the selection of BPH treatment methods in district-level hospitals. 【Methods】 The clinical data of 39 BPH patients who received surgical treatment in Chang’an Hospital during Jan.and Sep.2023 were retrospectively analyzed.The patients were divided into two groups, including 19 in blue laser group treated with 450 nm blue laser vaporization and 20 in the TURP group treated with transurethral resection of the prostate (TURP).The operation time, hemoglobin decline, postoperative bladder irrigation time, catheter indwelling time and adverse events were compared between the two groups. 【Results】 All operations were successfully completed.In the blue laser group, the operation time [(45.11±22.08) min vs.(81.25±29.37) min], postoperative bladder irrigation time [(34.05±9.41) h vs.(47.60±9.05) h] and the decrease of hemoglobin [(7.79± 5.86) g/L vs.(16.40±10.23) g/L] were significantly lower than those in the TURP group (P<0.05).There was 1 case of urinary retention in the blue laser group, and there was no significant difference in indwelling catheter time between the two groups (P>0.05). 【Conclusion】 The 450 nm blue laser vaporization of prostate has advantages of less blood loss, shorter operation time and shorter postoperative irrigation time.Therefore, it should be considered as a preferable option for BPH in primary hospitals.

Objective To compare the efficacy of ultrasound-guided microwave ablation versus thyroidectomy in the treatment of benign thyroid nodules (BTN) and to explore the influencing factors of prognosis. Methods A total of 282 BTN patients were enrolled and divided into ablation group (treated with ultrasound-guided microwave ablation, n=172) and resection group (treated with thyroidectomy, n=110) based on treatment methods. Perioperative indicators and thyroid function indices before and after surgery were compared between the two groups. Patients were followed up for 1 year and divided into good prognosis group [volume reduction rate (VRR)≥80%, n=210] and a poor prognosis group (VRR < 80%, n=72) based on the VRR. Factors influencing the prognosis of BTN patients were analyzed. Results The ablation group had shorter operative time and hospital stay, less intraoperative blood loss, and lower postoperative Visual Analogue Scale (VAS) scores compared to the resection group (P < 0.05). One month after surgery, serum thyrotropin (TSH) levels were higher, while free triiodothyronine (FT3) and free thyroxine (FT4) levels were lower than preoperative levels in both groups, however, TSH level was lower, and FT3 and FT4 levels were higher in the ablation group compared to the resection group (P < 0.05). Univariate analysis showed that preoperative TSH levels, the proportion of solid nodules, and the proportion of nodules in the risk zone were lower, while preoperative FT4 levels were higher in the good prognosis group compared to the poor prognosis group (P < 0.05). Binary Logistic regression analysis revealed that nodule type, nodule location, preoperative TSH, and preoperative FT4 were all influencing factors for the prognosis of BTN patients (P < 0.05). Conclusion Compared to thyroidectomy, ultrasound-guided microwave ablation for BTN offers advantages such as less intraoperative blood loss, milder postoperative pain, shorter operative time and hospital stay, and less damage to thyroid function. Preoperative TSH and FT4 levels, nodule type, and nodule location are closely related to the prognosis of BTN patients and should be given attention in clinical practice.

Histopathological evaluation based on liver biopsy is required to make a confirmed diagnosis of nonalcoholic fatty liver disease, differentiate nonalcoholic fatty liver (NAFL) from nonalcoholic steatohepatitis (NASH), and perform the grading and scoring of disease severity, while hematological and radiological examinations are often used in clinical practice. Although there have been a large number of studies on noninvasive models for fibrosis assessment and disease diagnosis in nonalcoholic fatty liver disease, the sensitivity and specificity of such models need to be further improved. This article reviews the main pathological features of NAFL and NASH, fibrosis and grading/staging/scoring systems, and the pathological diagnosis of NASH liver cirrhosis, in order to improve the awareness of the histological diagnosis of such disease among clinicians

Objective:To evaluate the influence of manual digitorum sensory stimulation (MDSS) of hemiplegic fingers in median nerve F-wave in stroke patients.Methods:Thirty patients with hemiplegia after stroke, admitted to Department of Rehabilitation Medicine, Second Affiliated Hospital of Anhui Medical University from June 2019 to October 2022 were selected; all patients had thumb flexor modified Ashworth scale (MAS) grading≥1. Hemiplegic MDSS was given; bilateral median nerve F-wave before MDSS and median nerve F-wave at the hemiplegic side immediately after MDSS were recorded.Results:Compared with that at the healthy side before MDSS, amplitude of median nerve F-wave at the hemiplegic side was significantly increased ( P<0.05). Compared with that before MDSS, amplitude of F-wave at the hemiplegic side after MDSS in patients with thumb flexor MAS grading≤2 were significantly decreased ( P<0.05), while that in patients with thumb flexor MAS grading≥3 was significantly increased ( P<0.05). Conclusion:Amplitudes of median nerve F-wave at the hemiplegic side in patients with different thumb flexor MAS grading show that MDSS can not only inhibit the excitability of tonic motor unit related to muscle spasm, but also enhance the excitability of kinetic-motor unit mainly related to explosive power in severe muscle spasm.