OBJECTIVE: To investigate the application of three-dimensional (3D) reconstruction technology in preoperative planning for anterolateral thigh flap transplantation. METHODS: A retrospective analysis was performed on the clinical data of 11 patients with skin and soft tissue defects treated with free anterolateral thigh flap transplantation between January 2022 and January 2024, who met the selection criteria. There were 8 males and 3 females, aged 34-70 years (mean, 50.8 years). Causes of injury included traffic accidents (4 cases), machine trauma (3 cases), heavy object crush injury (3 cases), and tumor (1 case). The time from injury to flap repair ranged from 7 to 35 days (mean, 23 days). Preoperatively, the patients' CT angiography images were imported into Mimics21.0 software. Through the software's segmentation, editing, and reconstruction functions, 3D visualization and measurement of the vascular pedicle, perforators, wound size, and morphology were performed to plan the flap harvest area, contour, vascular pedicle length, and anastomosis site, guiding the implementation of flap transplantation. RESULTS: The length of the vascular pedicle needed by the recipient site was (9.1±0.9) cm, and the maximum length of vascular pedicle in the donor area was (10.6±0.6) cm, with a significant difference ( t=4.230, P<0.001). The operation time ranged from 220 to 600 minutes (mean, 361.9 minutes). One patient had poor wound healing at the recipient site, which healed after dressing changes. All 11 flaps survived well without necrosis. All patients were followed up 6-19 months (mean, 11 months). Four flaps showed bulkiness and underwent secondary debulking; the remaining flaps had good contour and soft texture. The donor sites healed well, with no sensory disturbance around the incision or complications such as walking impairment. CONCLUSION Preoperative planning using CT angiography data and 3D reconstruction software can effectively determine the flap area, contour, required vascular pedicle length, anastomosis site, and whether vascular grafting is needed, thereby guiding the successful execution of anterolateral thigh flap transplantation.
Humans ; Middle Aged ; Male ; Female ; Adult ; Thigh/diagnostic imaging* ; Aged ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Imaging, Three-Dimensional/methods* ; Soft Tissue Injuries/surgery* ; Surgical Flaps ; Computed Tomography Angiography ; Free Tissue Flaps/blood supply* ; Preoperative Care

Guided by molecular networking, nine novel curvularin derivatives (1-9) and 16 known analogs (10-25) were isolated from the hydrothermal vent sediment fungus Penicillium sp. HL-50. Notably, compounds 5-7 represented a hybrid of curvularin and purine. The structures and absolute configurations of compounds 1-9 were elucidated via nuclear magnetic resonance (NMR) spectroscopy, X-ray diffraction, electronic circular dichroism (ECD) calculations, ¹³C NMR calculation, modified Mosher's method, and chemical derivatization. Investigation of anti-inflammatory activities revealed that compounds 7-9, 11, 12, 14, 15, and 18 exhibited significant suppressive effects against lipopolysaccharide (LPS)-induced nitric oxide (NO) production in murine macrophage RAW264.7 cells, with IC₅₀ values ranging from 0.44 to 4.40 μmol·L^-1. Furthermore, these bioactive compounds were found to suppress the expression of inflammation-related proteins, including inducible NO synthase (iNOS), cyclooxygenase-2 (COX-2), NLR family pyrin domain-containing protein 3 (NLRP3), and nuclear factor kappa-B (NF-κB). Additional studies demonstrated that the novel compound 7 possessed potent anti-inflammatory activity by inhibiting the transcription of inflammation-related genes, downregulating the expression of inflammation-related proteins, and inhibiting the release of inflammatory cytokines, indicating its potential application in the treatment of inflammatory diseases.
Penicillium/chemistry* ; Mice ; Animals ; Anti-Inflammatory Agents/isolation & purification* ; RAW 264.7 Cells ; Nitric Oxide/metabolism* ; Hydrothermal Vents/microbiology* ; Macrophages/immunology* ; Molecular Structure ; Nitric Oxide Synthase Type II/immunology* ; Cyclooxygenase 2/immunology* ; Geologic Sediments/microbiology* ; NF-kappa B/immunology* ; NLR Family, Pyrin Domain-Containing 3 Protein/immunology*

Ideological and political education within the curriculum of higher institutions of traditional Chinese medicine （TCM） not only bears the important responsibility of promoting China's outstanding traditional culture but also serves as a vital domain for upholding integrity and innovation in medical education. These institutions must profoundly comprehend the contemporary significance of curriculum-based ideological and political education， clarify its core role in talent cultivation， leverage the distinctive advantages of TCM culture， and promote the organic integration of ideological education and professional training. By reviewing the current situation and development trends of ideological and political education in the curriculum of higher TCM institutions， this paper has analyzed the challenges in teaching design， teachers' ideological and political literacy and competence， and the integration of ideological content with specialized courses， and has proposed implementation strategies such as using TCM culture as a guiding force， strengthening teachers' teaching capacity in ideological and political education， developing distinctive educational resources， and improving evaluation and incentive mechanisms. These strategies aim to effectively enhance the impact of ideological and political education in the new era， fostering well-rounded TCM talents with both moral integrity and professional competence.

Objective Exploring the performance of a sensitivity recognition model for neoadjuvant therapy based on ensemble learning algorithms for predicting neoadjuvant therapy sensitive patients.Methods In this study,255 rectal cancer patients who underwent standard neoadjuvant therapy and surgery at the Affiliated Cancer Hospital of Harbin Medical University were collected,of which 139 patients were sensitive to neoadjuvant therapy and 116 patients were not.The recursive feature elimination method was used to screen deep learning features and imaging histology features to construct an integrated learning model.The generalization performance of the model was verified using the leave-out method,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,G-mean,F-measure,Mathews correlation coefficient(MCC),and area under the receiver operating charactpristic curve(AUC)were used to evaluate and compare the model performance.Results The performance of the integrated model on the external validation set was:an AUC value of 0.916(95％CI:0.899 to 0.935),a sensitivity of 1.000,a specificity of 0.833,a positive predictive value of 0.875,a negative predictive value of 1.000,an accuracy of 0.923,a G-mean of 0.913,an F-measure of 0.933,a MCC was 0.854.Conclusion The integration model of depth features and imaging omics features is superior to the individual depth feature model and imaging omics feature model,and has good practicality and reliability in identifying sensitive patients with neoadjuvant therapy,which can be used as a reference for clinical practice.

Objective We improved the segmentation model TransUNet based on deep learning methods to construct a multitask model that can both segment regions of interest and predict classification,which made it possible to identify sensitive populations of patients undergoing neoadjuvant therapy for rectal cancer.Methods The multitask model added classification structure on the basis of TransUNet,including the fully connected layer(input of 512,output of 256),the ReLU activation function,and the fully connected layer(input of 256,output of 3),to achieve the prediction of triple classification outcomes(stable disease(SD),partial response(PD),and complete response(CR)).The 3D MRI of 71 rectal cancer patients before neoadjuvant chemotherapy admitted to the Harbin Medical University Cancer Hospital from 2015 to 2017 were extracted into 2D images as data for the study.Dice coefficient and Hausdorff distance were used to evaluate thesegmentation performance,and accuracy,micro-precision,micro-recall,and micro-F1 score were used for classification performance.Results The model was trained for 100 epochs,and the average Dice coefficient and average Hausdorff distance for the segmentation task on the test set were 0.851 and 10.806,respectively.For the classification task,the accuracy,micro-precision,micro-recall,and micro-F1 score on the test set were all 0.651 from the slicing perspective,and all four metrics were 0.857 from the patient perspective.Conclusion Our model works well in the segmentation task.Although the model performs poorly on the classification task at the slice level,the performance was acceptable at the patient level taking into account the tripartite classification results.The multitask model has the potential to be used in the clinic for assisted diagnosis.

Objective We improved the segmentation model TransUNet based on deep learning methods to construct a multitask model that can both segment regions of interest and predict classification,which made it possible to identify sensitive populations of patients undergoing neoadjuvant therapy for rectal cancer.Methods The multitask model added classification structure on the basis of TransUNet,including the fully connected layer(input of 512,output of 256),the ReLU activation function,and the fully connected layer(input of 256,output of 3),to achieve the prediction of triple classification outcomes(stable disease(SD),partial response(PD),and complete response(CR)).The 3D MRI of 71 rectal cancer patients before neoadjuvant chemotherapy admitted to the Harbin Medical University Cancer Hospital from 2015 to 2017 were extracted into 2D images as data for the study.Dice coefficient and Hausdorff distance were used to evaluate thesegmentation performance,and accuracy,micro-precision,micro-recall,and micro-F1 score were used for classification performance.Results The model was trained for 100 epochs,and the average Dice coefficient and average Hausdorff distance for the segmentation task on the test set were 0.851 and 10.806,respectively.For the classification task,the accuracy,micro-precision,micro-recall,and micro-F1 score on the test set were all 0.651 from the slicing perspective,and all four metrics were 0.857 from the patient perspective.Conclusion Our model works well in the segmentation task.Although the model performs poorly on the classification task at the slice level,the performance was acceptable at the patient level taking into account the tripartite classification results.The multitask model has the potential to be used in the clinic for assisted diagnosis.

Objective Exploring the performance of a sensitivity recognition model for neoadjuvant therapy based on ensemble learning algorithms for predicting neoadjuvant therapy sensitive patients.Methods In this study,255 rectal cancer patients who underwent standard neoadjuvant therapy and surgery at the Affiliated Cancer Hospital of Harbin Medical University were collected,of which 139 patients were sensitive to neoadjuvant therapy and 116 patients were not.The recursive feature elimination method was used to screen deep learning features and imaging histology features to construct an integrated learning model.The generalization performance of the model was verified using the leave-out method,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,G-mean,F-measure,Mathews correlation coefficient(MCC),and area under the receiver operating charactpristic curve(AUC)were used to evaluate and compare the model performance.Results The performance of the integrated model on the external validation set was:an AUC value of 0.916(95％CI:0.899 to 0.935),a sensitivity of 1.000,a specificity of 0.833,a positive predictive value of 0.875,a negative predictive value of 1.000,an accuracy of 0.923,a G-mean of 0.913,an F-measure of 0.933,a MCC was 0.854.Conclusion The integration model of depth features and imaging omics features is superior to the individual depth feature model and imaging omics feature model,and has good practicality and reliability in identifying sensitive patients with neoadjuvant therapy,which can be used as a reference for clinical practice.

Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.

Guided by the concept of "blood-pulse-heart-spirit"， it is believed that stable angina combined with insomnia is caused by disturbance of blood vessels， which leads to loss of nourishment for the heart body and heart spirit， so the core treatment principle is to regulate the blood vessels and calm the mind. At the beginning of the disease， it shows as the liver fails to govern the free flow of qi， and disorders qi and blood； during the progress of the disease， it shows as spleen deficiency and phlegm stagnation， phlegm and blood stasis obstructing the vessels； the central mechanism of the disease shows as disturbance of blood vessels and insufficient heart yin. For the pattern of liver depression and blood stasis， pattern of phlegm and blood stasis blocking the vessels， and pattern of heart yin deficiency， it is recommended to treat by Wuzang Shenning Formula （五脏神宁方） to dredge the liver and regulate the vessels， Banxia Houpo Decoction （半夏厚朴汤） plus Gualou Xiebai Banxia Decoction （瓜蒌薤白半夏汤） to dissolve phlegm and regulate the vessels， and Yunpi Tiaoxin Decoction （运脾调心汤） to nourish the yin and regulate the vessels. Throughout the treatment， pattern differentiation and treatment is accompanied by the method of calming the mind with heavy sedatives and nourishing the blood to calm the mind， so as to achieve the purpose of regulating mind and heart together and treating the body and spirit at the same time.

Objective:To investigate the risk factors and their warning effectiveness for meniscus tear secondary to delayed anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective cohort study was conducted to analyze the clinical data of 114 patients (114 knees) with ACL injury, who were admitted to Affiliated Hospital of Nanjing University of Chinese Medicine from December 2018 to December 2023, including 78 males and 36 females, aged 11-50 years [29(21, 35)years]. The patients were divided into tear group ( n=46) and non-tear group ( n=68) according to whether combined with meniscus tear or not during the surgery. Gender, age, duration of disease, smoking history, Body Mass Index (BMI), cause of injury, mechanism of injury, side of the injury, Beighton score, difference of KT-2000 examination, Tegner activity scale of the knee joint, anterior tibial translation sign, medial posterior tibial slope angle, lateral posterior tibial slope angle, and pivot shift grading of the patients in the two groups were recorded. Correlations between the above-mentioned indicators and occurrence of meniscus tear secondary to delayed ACL reconstruction were assessed. In the meantime, the independent risk factors were determined by univariate and multivariate binary logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the warning effectiveness of each risk factor for meniscal tear secondary to delayed ACL reconstruction. Results:Univariate analysis showed correlation of duration of disease, BMI, Tegner activity scale of the knee joint, medial posterior tibial slope angle, lateral posterior tibial slope angle and high-grade pivot shift with occurrence of meniscus tear secondary to delayed ACL reconstruction ( P<0.01). The results of multivariate binary logistic regression analysis showed that the duration of disease ≥14.5 weeks ( OR=1.20, 95% CI 1.05, 1.38, P<0.01), BMI≥26.9 kg/m 2 ( OR=1.36, 95% CI 1.03, 1.81, P<0.05), Tegner activity scale of the knee joint ≥4 points ( OR=2.29, 95% CI 1.18, 4.46, P<0.05), medial posterior tibial slope angle ≥11.2° ( OR=2.27, 95% CI 1.06, 4.89, P<0.05) and high-grade pivot shift ( OR=0.03, 95% CI 0.01, 0.03, P<0.05) were significantly correlated with occurrence of meniscus tear secondary to delayed ACL reconstruction. Results of ROC curve analysis showed that the medial posterior tibial slope angle (AUC=0.86, 95% CI 0.80, 0.93) and duration of disease (AUC=0.85, 95% CI 0.77, 0.92) had good warning value, BMI (AUC=0.78, 95% CI 0.69, 0.87) and Tegner activity scale of the knee joint (AUC=0.73, 95% CI 0.64, 0.83) had ordinary warning value, and the warning value of high-grade pivot shift (AUC=0.60, 95% CI 0.49, 0.71) was the lowest. The combination of the risk factors revealed superior warning effectiveness for meniscus tear second to delayed ACL reconstruction (AUC=0.97, 95% CI 0.96, 1.00). Conclusions:The duration of disease ≥14.5 weeks, BMI ≥26.9 kg/m 2, Tegner score ≥4 points, medial posterior tibial slope angle ≥11.2°and high-grade pivot shift are independent risk factors for meniscus tear secondary to delayed ACL reconstruction. The medial posterior tibial slope angle and duration of disease have good warning value, BMI and Tegner scores have ordinary warning value and high-grade pivot shift has the lowest warning value. The combination of the above risk factors has better warning effectiveness for meniscus tear secondary to delayed ACL reconstruction.