Objective To investigate the correlation between early clinical outcomes following endoscopic surgery for unilateral lumbar disc herniation and variations in the cross-sectional area of the sciatic nerve.Methods Fifty-two patients(n=52)with unilateral lumbar disc herniation were recruited from June 2023 to June 2024 at the Pain Department of the First Affiliated Hospital of Nanchang University.The cross-sectional area(CSA)values of bilateral sciatic nerves were measured at the gluteal sciatic tuberosity-great femoral rotor level using ultrasound before and on the 4th day after surgery.The change in nerve cross-sectional area ΔCSA and sciatic nerve swelling rate(SR-SN)were calculated.Patient BMI(Body Mass Index),visual analog scale(VAS),Japanese Orthopaedic Association score(JOA),Oswestry Disability Index(ODI),and Treatment Improvement Rate(TIR)were collected preoperatively and on postoperative day 4.Changes in sciatic nerve cross-sectional area in unilateral lumbar disc herniation and its relationship to clinical outcomes were analyzed using the scoring scales as controls.Results Compared to the preoperative period,there was a significant decrease in VAS and ODI scores,as well as an increase in JOA score on the 4th postoperative day(P<0.01).Furthermore,surgical intervention led to substantial improve-ment in clinical outcomes for the patients.Prior to surgery,the CSA value of the affected side of the sciatic nerve was greater than that of the healthy side(P<0.01).Although CSA value decreased on the affected side after surgery,it remained higher than that of the healthy side(P<0.01).Additionally,there was a significant difference between SR-SN values on both sides with higher values observed on the affected side(P<0.01).Notably,△CSA on the affected side exhibited a negative correlation with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05);The SR-SN on the affected side exhibited a positive correlation with BMI and negative correlations with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05).However,no significant correlations were observed between △CSA,SR-SN,and ODI score on the affected side.(P>0.05).Conclusions In patients undergoing endoscopic surgery for lumbar disc herniation,a greater change in the cross-sectional area of the affected sciatic nerve before and after the operation is associated with more pronounced improvement in early symptoms.However,further investigation is required to explore the relationship between this change and recovery of both lumbar spine and lower limb function.

Central venous lesion represents one of the common complications affecting vascular access in hemodialysis patients, potentially compromising hemodialysis efficacy. The management of symptomatic central venous lesion remains a critical challenge in clinical practice. Current primary treatment strategies include percutaneous transluminal angioplasty and percutaneous transluminal stenting. Advances in techniques such as sharp recanalization and the mother-child platform approach, along with the development of high-pressure balloons, paclitaxel- coated balloons, and covered stents, have significantly improved procedural success rates. However, unresolved issues persist, including standardized treatment protocols, technical considerations for lesion traversal, and optimal stent selection criteria. This article comprehensively reviews the treatment principles, lesion passage techniques, treatment techniques, and recent advancements of central venous lesion.

Objective·To develop a graph neural network(GNN)-based auxiliary diagnostic model for gallbladder cancer on CT images,and validate its accuracy and feasibility.Methods·From January 2010 to November 2023,1 774 contrast-enhanced CT arterial-phase images were acquired from 887 patients with normal gallbladder,benign gallbladder disease,or gallbladder cancer at Xinhua Hospital and Renji Hospital,Shanghai Jiao Tong University School of Medicine.These images were randomly divided into training and testing sets at a 4∶1 ratio to develop a hybrid GNN-convolutional neural network(CNN)model,named VJK-GIN.The model constructed a pixel-level graph in which each pixel served as a node,and spatial adjacency defined the edges,enabling extraction of local texture features.In the model architecture design,VJK-GIN integrated a three-layer graph isomorphism network,augmented with virtual nodes and jump-knowledge connections;global pooling compressed node features into a graph-level representation,which was classified by a multi-layer perceptron head.Five-fold cross-validation was used to compare VJK-GIN with GNN baselines(GCN,GraphSAGE,GAT,and GIN)and CNN baselines(ViT,EfficientNetV2,and ConvNeXt)in terms of accuracy,precision,recall,F1-score,and area under the receiver operating characteristic curve(AUC).Results·The results of five-fold cross-validation showed that VJK-GIN achieved an F1-score of 0.799(95%CI 0.775?0.823),recall of 0.795(95%CI 0.773?0.817),precision of 0.799(95%CI 0.775?0.823),AUC of 0.812(95%CI 0.792?0.832),and accuracy of 0.773(95%CI 0.748?0.798),surpassing all competing models across every metric.Conclusion·The VJK-GIN model exhibits high stability and accuracy in identifying contrast-enhanced CT images of normal,benign,and malignant gallbladder conditions.

Objective To evaluate the effectiveness of thermal tomography in breast cancer (BC) screening. Methods We conducted a general population-based BC screening in three regions of Hubei Province (Xiantao, Hongan, and Yangxin Districts). Participants underwent a questionnaire-based interview for baseline data collection. They then received a physical examination, thermal tomography, and ultrasound from doctors and technicians. We compared the efficacies, including sensitivity, specificity, and false-positive rates, of ultrasound and thermal tomography in BC screening. Results A total of 59 712 eligible women were included in this screening program. The BI-RADS 1, 2, 3, 4, and 5 accordance rates between the two screening methods were 0.9549, 0.8047, 0.9037, 0.3352, and 0, respectively. The overall accordance rate was 0.933 1. The kappa consistency results showed that the Cicchetti-Allison and Fleiss-Cohen kappa values were 0.7970 and 0.8583, respectively. Although the two methods had equal sensitivities, specificity was higher in thermal tomography than in ultrasound. The false-positive rate was lower in thermal tomography than in ultrasound. The area under the receiver operating characteristic (ROC) curve of thermal tomography was significantly larger than that of ultrasound. Conclusion The general consistency between thermal tomography and ultrasound in BC screening was high. Thermal tomography outperformed ultrasound in terms of specificity and diagnostic efficiency. Therefore, thermal tomography has a high application value for general population-based BC screening.

Objective To investigate the clinical efficacy of Pinggan Capsules(composed of six Chinese herbs,i.e.Gentianae Radix et Rhizoma,Prunellae Spica,Rehmanniae Radix,Gastrodiae Rhizoma,Gardeniae Fructus and Plantaginis Herba)in treating patients with hypertension complicated with anxiety and depression of liver-yang hyperactivity type,and to explore the related influencing factors of efficacy.Methods A total of 150 patients diagnosed as hypertension complicated with anxiety and depression of liver-yang hyperactivity type treated at Guangdong Second Traditional Chinese Medicine Hospital from January 2022 to January 2023 were enrolled.The patients were randomly divided into the trial group and the control group using a random number table,with 75 cases in each group.The control group received conventional medicine treatment(Amlodipine Besylate Tablets plus Losartan Potassium Tablets),while the trial group received Pinggan Capsules in addition to the conventional treatment.The treatment for the two groups lasted for 8 weeks.Before and after treatment,the changes in blood pressure,Self-Rating Anxiety Scale(SAS)scores,Self-Rating Depression Scale(SDS)scores,and scores of each domain of World Health Organization Quality of Life-BREF(WHO-QOL-BREF)were observed in the two groups.Antihypertensive efficacy,TCM syndrome efficacy,and drug safety in the two groups were evaluated,and the main factors influencing the efficacy of Pinggan Capsules were analyzed.Results(1)During the treatment period,6 cases dropped out from the trial group and 4 cases dropped out from the control group.A total of 140 patients completed the full course of treatment,including 69 in the trial group and 71 in the control group.(2)After 8 weeks of treatment,the total effective rate for antihypertensive efficacy in the trial group was 89.86%(62/69),significantly higher than that in the control group[64.79%(46/71)].The intergroup(tested by chi-square test)showed that the antihypertensive efficacy of the trial group was significantly superior to that of the control group(P＜0.05).(3)After 8 weeks of treatment,the total effective rate for TCM syndrome efficacy in the trial group was 92.75%(64/69),significantly higher than that in the control group[66.20%(47/71)].The intergroup(tested by chi-square test)showed that the TCM syndrome efficacy of the trial group was significantly superior to that of the control group(P＜0.05).(4)After treatment,systolic blood pressure and diastolic blood pressure were improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the scores of all domains(physical,psychological,social relationships,and environmental)of WHO-QOL-BREF scale were significantly improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to in the control group(P＜0.05).(6)After treatment,SAS and SDS scores were significantly improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to that in the control group(P＜0.05).(7)No significant adverse reactions occurred in either group during the treatment period,indicating high safety.(8)Sankey diagram and correspondence analysis showed that patients aged＜65 years,male,grade 1 hypertension,mild anxiety,and mild depression achieved significant hypotensive effect and symptom-relief effect(P＜0.05).Conclusion Pinggan Capsules have significant clinical efficacy in treating hypertension complicated with anxiety and depression of liver-yang hyperactivity type and is worthy of clinical promotion and application.

Objective To investigate the correlation between early clinical outcomes following endoscopic surgery for unilateral lumbar disc herniation and variations in the cross-sectional area of the sciatic nerve.Methods Fifty-two patients(n=52)with unilateral lumbar disc herniation were recruited from June 2023 to June 2024 at the Pain Department of the First Affiliated Hospital of Nanchang University.The cross-sectional area(CSA)values of bilateral sciatic nerves were measured at the gluteal sciatic tuberosity-great femoral rotor level using ultrasound before and on the 4th day after surgery.The change in nerve cross-sectional area ΔCSA and sciatic nerve swelling rate(SR-SN)were calculated.Patient BMI(Body Mass Index),visual analog scale(VAS),Japanese Orthopaedic Association score(JOA),Oswestry Disability Index(ODI),and Treatment Improvement Rate(TIR)were collected preoperatively and on postoperative day 4.Changes in sciatic nerve cross-sectional area in unilateral lumbar disc herniation and its relationship to clinical outcomes were analyzed using the scoring scales as controls.Results Compared to the preoperative period,there was a significant decrease in VAS and ODI scores,as well as an increase in JOA score on the 4th postoperative day(P<0.01).Furthermore,surgical intervention led to substantial improve-ment in clinical outcomes for the patients.Prior to surgery,the CSA value of the affected side of the sciatic nerve was greater than that of the healthy side(P<0.01).Although CSA value decreased on the affected side after surgery,it remained higher than that of the healthy side(P<0.01).Additionally,there was a significant difference between SR-SN values on both sides with higher values observed on the affected side(P<0.01).Notably,△CSA on the affected side exhibited a negative correlation with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05);The SR-SN on the affected side exhibited a positive correlation with BMI and negative correlations with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05).However,no significant correlations were observed between △CSA,SR-SN,and ODI score on the affected side.(P>0.05).Conclusions In patients undergoing endoscopic surgery for lumbar disc herniation,a greater change in the cross-sectional area of the affected sciatic nerve before and after the operation is associated with more pronounced improvement in early symptoms.However,further investigation is required to explore the relationship between this change and recovery of both lumbar spine and lower limb function.

Objective·To develop a graph neural network(GNN)-based auxiliary diagnostic model for gallbladder cancer on CT images,and validate its accuracy and feasibility.Methods·From January 2010 to November 2023,1 774 contrast-enhanced CT arterial-phase images were acquired from 887 patients with normal gallbladder,benign gallbladder disease,or gallbladder cancer at Xinhua Hospital and Renji Hospital,Shanghai Jiao Tong University School of Medicine.These images were randomly divided into training and testing sets at a 4∶1 ratio to develop a hybrid GNN-convolutional neural network(CNN)model,named VJK-GIN.The model constructed a pixel-level graph in which each pixel served as a node,and spatial adjacency defined the edges,enabling extraction of local texture features.In the model architecture design,VJK-GIN integrated a three-layer graph isomorphism network,augmented with virtual nodes and jump-knowledge connections;global pooling compressed node features into a graph-level representation,which was classified by a multi-layer perceptron head.Five-fold cross-validation was used to compare VJK-GIN with GNN baselines(GCN,GraphSAGE,GAT,and GIN)and CNN baselines(ViT,EfficientNetV2,and ConvNeXt)in terms of accuracy,precision,recall,F1-score,and area under the receiver operating characteristic curve(AUC).Results·The results of five-fold cross-validation showed that VJK-GIN achieved an F1-score of 0.799(95%CI 0.775?0.823),recall of 0.795(95%CI 0.773?0.817),precision of 0.799(95%CI 0.775?0.823),AUC of 0.812(95%CI 0.792?0.832),and accuracy of 0.773(95%CI 0.748?0.798),surpassing all competing models across every metric.Conclusion·The VJK-GIN model exhibits high stability and accuracy in identifying contrast-enhanced CT images of normal,benign,and malignant gallbladder conditions.

Central venous lesion represents one of the common complications affecting vascular access in hemodialysis patients, potentially compromising hemodialysis efficacy. The management of symptomatic central venous lesion remains a critical challenge in clinical practice. Current primary treatment strategies include percutaneous transluminal angioplasty and percutaneous transluminal stenting. Advances in techniques such as sharp recanalization and the mother-child platform approach, along with the development of high-pressure balloons, paclitaxel- coated balloons, and covered stents, have significantly improved procedural success rates. However, unresolved issues persist, including standardized treatment protocols, technical considerations for lesion traversal, and optimal stent selection criteria. This article comprehensively reviews the treatment principles, lesion passage techniques, treatment techniques, and recent advancements of central venous lesion.

Background Long-term exposure to free silica particles will lead to fibrosis of lung tissue, and abnormal expression of microRNA (miRNA) may affect the occurrence and process of fibrosis. Objective To observed possible intervention effect of miR-204-3p overexpression adenovirus on silicosis fibrosis induced by silica dust using a silicosis rat model via non-exposed intratracheal instillation. Methods Forty SD rats were randomly divided into four groups: control group, silicosis model group, miRNA-NC group, and miR-204-3p intervention group. Under ether anesthesia, rats in the silicosis model group, miRNA-NC group, and miR-204-3p intervention group were injected with 1 mL (50 mg·mL⁻¹) of free silica dust suspension into the trachea, while the control group was injected with the same volume of normal saline. After 30 d of dust exposure, the miR-204-3p intervention group was injected with rno-mir-204 adenovirus vector to overexpress miR-204-3p, and the miRNA-NC group was given empty virus vector. After 30 d of normal feeding, the animals were sacrificed by chloral hydrate anesthesia, and the lung tissue was taken for subsequent experiments. The relative expression level of miR-204-3p in lung tissue of rats in each group was detected by real-time fluorescence quantitative PCR (RT-qPCR). HE staining, Masson staining, and Sirius red staining were used for pathological observation. Immunohistochemistry was used to detect the expression of Fibronectin and Collagen I in lung tissue of rats in each group. RT-qPCR was used to detect the relative gene expression levels of fibrosis markers Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in each group. Western blot was used to detect the protein expression levels of fibrosis markers Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in each group. Results The anatomical features of lung tissue in the control group were pink lung tissue with soft texture and smooth surface, while those in the silicosis model were grayish white tissue with hard texture and scars and grayish white silicon nodules on the surface. Compared with the silicosis model group, the color of lung tissue in the miR-204-3p intervention group became ruddy, the surface was smooth, and the texture became soft. The staining results showed that the alveolar wall of the control group was thin, there were a small number of capillaries in the alveoli, and the alveolar structure was clear and complete. In the silicosis model group, the alveolar wall became thicker, the pulmonary septum was partially broken, the alveolar structure was defective, and a large amount of collagen fibers were deposited. The alveolar structure of the miR-204-3p intervention group was relatively clear and there was a small amount of collagen fiber deposition. RT-qPCR results showed that compared with the control group, the relative expression levels of miR-204-3p in lung tissue of the silicosis model group and the miRNA-NC group were decreased (P<0.05), and the relative expression level of miR-204-3p in lung tissue of the miR-204-3p intervention group was increased (P＜0.05). The results of immunohistochemistry showed that compared with the control group, the expression levels of Fibronectin and Collagen I in lung tissue of the silicosis model group were increased (P＜0.05). Compared with the silicosis model group, the relative expression levels of Fibronectin and Collagen I in lung tissue of the rats in the miR-204-3p intervention group were significantly decreased (P<0.05). The results of RT-qPCR and Western blot showed that compared with the control group, the relative protein and gene expression levels of fibrosis factors Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of the silicosis model group increased (P＜0.05). Compared with the silicosis model group, the relative gene and protein expression levels of fibrosis factors Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in the miR-204-3p intervention group were decreased (P＜0.05). Conclusion Silica dust can cause lung fibrosis in rats, and overexpression of miR-204-3P in vivo can reduce silicosis fibrosis in rats caused by silica dust.

BACKGROUND:Prosthesis loosening and wear are still the main problems in the failure of total ankle replacement,which are closely related to the micro-motion of the implant-bone interface,the contact stress of the articular surface and joint motion.The design of artificial joint components,including insert and tibial/talar stem prosthesis,is a key factor affecting the force,motion,and micromotion of the contact interface of the ankle joint.The development of new inserts is of great significance to improve the survival rate of artificial ankle joints. OBJECTIVE:The finite element model of the total ankle replacement model was constructed to detect the biomechanical properties of the porous structure-optimized inserts,and the effect of the porous structure-optimized inserts on reducing prosthesis micromotion and improving the contact behavior of the articular surface was analyzed. METHODS:Based on the CT scan data of the right ankle joint of a healthy adult and the INBONE Ⅱ system product manual,a three-dimensional model including bone and artificial joint system was established,and the total ankle replacement model(model A)was obtained after osteotomy and prosthesis installation,and then through four new types of inserts,G50,G60,D50,and D60,were obtained by transforming the porous structure of the original insert,and the original one was replaced with different inserts to establish an optimized total ankle replacement model(models B-E)corresponding to the inserts.The gait loads were applied on the five models to simulate the gait conditions.The differences in micromotion and articular surface contact behaviors at the implant-bone interface of all five models were compared. RESULTS AND CONCLUSION:(1)In the gait cycle,the micromotion of the prosthesis of the four optimized total ankle replacement models was lower than that of the original model.Compared with model A,the micromotion of the prosthesis in models B-E decreased by 5.4%,10.1%,8.1%,and 20.9%,respectively.The high micromotion area of t ??he tibial groove dome in the optimized model was significantly smaller than that of the original model.(2)The four optimized models obtained a larger articular surface contact area.Compared with model A,the average contact area of t ??he inserts in models B-E increased by 11.8%,14.7%,8.1%,and 32.6%,respectively.(3)Similar to the effect of increasing the contact area,compared with the original model,the contact stress of the optimized model decreased in varying degrees,and the value of model E decreased the most significantly(P<0.05),it is due to good mechanical properties and large porosity of the Diamond lattice that constitutes the D60-type insert.(4)The research results show that the use of porous structure to improve the inserts can improve the elasticity of the inserts and increase its ability to absorb joint impact,for favorable conditions are created for reducing micromotion at the implant-bone interface and improving joint contact behavior.