Objective: To investigate the protective effects and underlying mechanisms of sodium pyruvate (SP) on RBC storage lesions using an oxidative damage model. Methods: Six units of leukocyte-depleted suspended RBCs (discarded for non-infectious reasons within three days post-collection) were randomly assigned to four groups: negative control (NS), positive control (PS), experimental group 1 (SP1), and experimental group 2 (SP2). Oxidative stress was induced in the PS group by the addition of hydrogen peroxide (H O ), while SP1 and SP2 received SP supplementation at different concentrations (25 mM and 50 mM, respectively) in the presence of H O . After 1 hour of incubation, RBC morphology was assessed microscopically, and biochemical indicators including glutathione (GSH), malondialdehyde (MDA), methemoglobin (MetHb), adenosine triphosphate (ATP), and Na /K -ATPase activity were measured. Results: RBCs in the PS group exhibited pronounced morphological damage, including cell shrinkage and echinocyte formation, whereas both SP-treated groups showed significantly reduced structural injury. SP treatment led to elevated GSH levels and decreased concentrations of MDA and MetHb, suggesting attenuation of oxidative stress. Additionally, SP enhanced intracellular ATP levels and Na /K -ATPase activity, thereby contributing to membrane stability. Notably, the SP2 group (50 mM) demonstrated superior protective effects compared to SP1 (25 mM). Conclusion: Sodium pyruvate effectively attenuates oxidative storage lesions in RBCs, primarily through its antioxidant properties, energy metabolism supporting ability, and celluar membrane stabilizing function. These findings suggest SP as a promising additive for enhancing the quality and safety of stored RBCs.

Objective:To analyze the preferences of outpatients in a tertiary public specialized hospital, for references for optimizing the allocation of outpatient medical resources, and enhancing the medical experience.Methods:This study used convenience sampling method to select outpatients from a tertiary public stomatological hospital from January to September 2022 as the survey subjects, and conducted a questionnaire survey. The questionnaire mainly included gender, age, place of residence, education level, and medical needs, etc. Logistic regression model and Boruta algorithm were used to analyze the factors influencing patients′ preferred tertiary public specialized hospitals for treatment.Results:A total of 19 255 patients were included in this study. 13 558 patients (70.41%) preferred tertiary public specialized hospital for treatment, including 9 715 patients (71.65%) aged 21 to 45, 1 015 local patients (73.87%), 8 278 patients (61.05%) who chose treatment options, and 6 442 patients (47.51%) who came to the hospital for medical insurance reimbursement. By logistic regression analysis, age, residence, education level, medical needs, oral health habits, access to oral health knowledge, pre interview experience of Internet hospitals, monthly income, number of family members and reasons for seeking medical treatment were the influencing factors of patients′ preference for tertiary public specialized hospitals. According to the Boruta algorithm analysis, the top 6 important factors were the reasons for seeking medical treatment (Z=126.66), oral health habits (Z=96.44), access to oral health knowledge (Z=66.91), medical needs (Z=62.21), age (Z=57.54), and residence (Z=55.21).Conclusions:Local patients and young and middle-aged patients tended to choose tertiary public specialized hospitals for treatment, and treatment projects were the main business types that attract patients to visit tertiary public specialized hospitals. There were many important influencing factors for patients choosing tertiary public specialized hospitals for treatment, including the reasons for seeking medical treatment, oral health habits, access to oral health knowledge, and medical needs.

OBJECTIVE: To propose a non-contrast CT-based algorithm for automated and accurate detection of pancreatic lesions at a low cost. METHODS: With Faster RCNN as the benchmark model, an advanced Faster RCNN (aFaster RCNN) model for pancreatic lesions detection based on plain CT was constructed. The model uses the residual connection network Resnet50 as the feature extraction module to extract the deep image features of pancreatic lesions. According to the morphology of pancreatic lesions, 9 anchor frame sizes were redesigned to construct the RPN module. A new Bounding Box regression loss function was proposed to constrain the training process of RPN module regression subnetwork by comprehensively considering the constraints of the lesion shape and anatomical structure. Finally, a detection frame was generated using the detector in the second stage. The data from a total of 728 cases of pancreatic diseases from 4 clinical centers in China were used for training (518 cases, 71.15%) and testing (210 cases, 28.85%) of the model. The performance of aFaster RCNN was verified through ablation experiments and comparison experiments with 3 classical target detection models SSD, YOLO and CenterNet. RESULTS: The aFaster RCNN model for pancreatic lesion detection achieved recall rates of 73.64% at the image level and 92.38% at the patient level, with an average precision of 45.29% and 53.80% at the image and patient levels, respectively, which were higher than those of the 3 models for comparison. CONCLUSION The proposed method can effectively extract the imaging features of pancreatic lesions from non-contrast CT images to detect the pancreatic lesions.
Humans ; Pancreas/diagnostic imaging* ; Algorithms ; China ; Pancreatic Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed

Objective:To compare the clinical and imaging outcomes of fascia lata autograft bridging repair reinforecd with an artificial ligament as the internal brace with the autograft bridging repair for the treatment of irreparable massive rotator cuff tears (IMRCTs).Methods:The data of 26 patients with IMRCT who underwent fascia lata autograft bridging repair augmented with artificial ligament as the internal brace (internal brace group) and of 24 patients with IMRCT who underwent bridging autograft repair alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed using shoulder activity, the American Shoulder and Elbow Surgeons (ASES) Score, University of California Los Angeles (UCLA) Score, and visual analogue scale (VAS) for pain. Imaging outcomes were evaluated using acromiohumeral distance (AHD), Goutallier grade, and status of fascia lata grafts according to radiographs or magnetic resonance imaging results.Results:All 50 cases were followed up for 34.2±7.2 months (range 24-45 months). Compared to the control group, the internal brace group showed better ASES score (93.5±5.3 vs. 89.5±5.7, P<0.05), UCLA score (31.7±3.8 vs. 28.5±5.6, P<0.05), improvement in UCLA score (19.6±4.2 vs. 15.9±5.7, P<0.05), active elevation (167.3°±8.4° vs. 159.4°±13.6°, P<0.05), abduction strength (8.9±1.2 vs. 8.2±1.2, P<0.05), improvement in abduction strength (4.1±1.2 vs. 3.3± 1.0, P<0.05), AHD (7.0±1.4 mm vs. 5.9±1.0 mm, P<0.05), improvement in AHD (3.3±1.5 mm vs. 2.0±0.6 mm, P<0.05), and healing rate of fascia lata autografts (92% vs. 54%, P<0.05) at 2-year follow-up. Conclusion:Fascia lata autograft bridging repair reinforced with an artificial ligament as the internal brace improves healing rate of bridging graft and postoperatively short-term clinical outcomes of patients with IMRCT.

Objective:To construct the post competency evaluation index system for Da Vinci robot specialist nurses based on onion model, so as to provide references for the training and evaluation of Da Vinci robot specialist nurses in China.Methods:From August to September 2022, using the "onion model" as the theoretical framework, a preliminary draft of the index system was developed using domestic and foreign literature review, semi-structured interviews and group discussions. The Delphi method was applied to 22 nursing experts in the relevant fields to conduct two rounds of expert correspondence, screen and modify the items, and calculate the weight using the analytic hierarchy process. Finally, the post competency index system for Da Vinci robot specialist nurses based on the onion model was formed.Results:Two rounds of expert correspondence were conducted. The positive coefficient of experts was 90.91% (20/22) in the first round and 100.00% (20/20) in the second round, the coefficient of expert authority was 0.840 and 0.873, and the Kendall's coordination coefficient was 0.181 and 0.324 ( P<0.01), respectively. The final post competency evaluation index system for Da Vinci robot specialist nurses consisted of 4 first-level indicators, 14 second-level indicators and 58 third-level indicators. Conclusions:This study constructs a comprehensive post competency evaluation index system for Da Vinci robot specialist nurses based on onion model, with high expert enthusiasm and authority. It can provide references for the training and evaluation of Da Vinci robot specialist nurses in China.

Objective: To create a model for early prediction of essential hypertension (EH) based on the TreeNet algorithm, so as to provide a tool for early monitoring of EH. Methods: The health examination data were collected from individuals receiving health examinations in Hangzhou Haiqin Health Examination Center or Shanghai Yibao Health Management Co., Ltd from 2014 to 2016, and a predictive model for EH was created based on the TreeNet algorithm. The effectiveness of the model for early prediction of EH was evaluated using root mean square error (RMSE), mean absolute deviation (MAD), coefficient of determination (R2) and receiver operating characteristic (ROC) curve. Results: A total of 12 variables were included in the model, and the highest contributing variable was body mass index (BMI), followed by BMI difference, two-year BMI difference, two-year triglyceride (TG) difference, two-year total cholesterol (TC) difference, high-density lipoprotein cholesterol (HDL-C) in 2014, TG in 2014, low-density lipoprotein cholesterol (LDL-C) in 2014, body weight in 2015, fasting blood glucose in 2015, TG in 2015, urea nitrogen difference and platelet in 2015. The highest predictive accuracy was 100.00%, and the lowest was 56.89%. The risk of EH significantly increased among individuals with BMI in 2015 of >25 kg/m2, two-year BMI difference of >0.5 kg/m2, two-year TG difference ranging from 1.3 to 3.3 mmol/L, TC in 2015 of 2.0 to 2.4 mmol/L and HDL-C in 2014 of <0.52 mmol/L. The model presented RMSE of 0.082, MAD of 0.064, R2 of 0.811, area under the ROC curve of 0.788 (95%CI: 0.741-0.815), sensitivity of 69.05% and specificity of 66.21% for prediction of EH Conclusion The TreeNet algorithm-based model is effective for early monitoring of high-risk individuals for EH.

The oral specialist diagnosis and treatment has the characteristics of diagnosis and treatment behavior immediacy, phased diagnosis and treatment process, diagnosis and treatment population diversity, diagnosis and treatment effect subjectivity, and patient dominance of outpatient medical record storage. In the process of fulfilling the notification obligation, there may be risks such as the protection of the autonomous rights and interests of minor patients, the limited communication time, the insufficient clarity of the first diagnosis plan, the new requirements for the performance form, and the expansion of the application of the presumption of fault. The oral specialist diagnosis should pay attention to the true expression of the informed object; the diversification of the informative channels to obtain the clear attitude of the patient; the optimization of the informative process to make up for the information imbalance; the strict implementation of the core medical safety system to promote the actual fulfillment of the notification obligation.

Objective To evaluate the value of fast track surgery (FTS) in laparoscopic hepatectomy.Methods The clinical data of 142 patients undergoing laparoscopic liver resection from January 2014 to January 2016 were analyzed retrospectively.74 patients received fast track surgery treatment (FTS group) and 68 patients received traditional treatment methods (control group).Results Compared with control group,FTS group had a shorter operative time and less blood lose (t =2.279,t =2.432,P ＜0.05),quicker postoperative intestinal function recovery (t =3.548,P ＜ 0.05),a shorter postoperative hospitalization time (t =2.821,P ＜ 0.05),a lower hospitalization cost (t =2.507,P ＜ 0.05),a lower postoperative VAS scores (t =3.394,t =3.176,t =7.079,P ＜ 0.05) in 3 post-op successive days.There were 3 patients with major post-op complications in FTS group (4.05％,3/74) compared with 4 cases in control group (5.88％,4/68) (x2 =0.253,P ＞ 0.05).Conclusion The application of fast track surgery in laparoscopic liver resection is safe and effective,and helpful in reducing patients' inhospital cost.

Objective To explore the insula sensory features and analyze its electrophysiological characteristics based on stereo-electroencephalograph (SEEG).Methods The clinical data of 16 drug-refractory epilepsy patients,admitted to our hospital from December 2013 to June 2016,were retrospectively analyzed.All patients were implanted with SEEG electrodes;totally,34 electrodes (257 contacts) located in insular lobe.Micro current stimulation was performed every adjacent two contacts to get the sensory mapping and the stimulus threshold of the insula.Results Of all the 257 contacts,160 presented clinical symptoms (positive contacts);there were 149 contacts with sensory manifestations,of which 72 were on the left side and 77 on the right.Sensory symptoms of insula mainly included both somatic sensation and visceral sensation.The threshold of somatosensory was (4.9±2.9) mA,and the threshold of visceral sensation was (6.0±2.9) mA,without significant difference (P＞0.05).No significant difference was noted between the left insula sensory ([6.2±3.1] mA) and the right insula sensory ([5.7±2.8] mA,P＞0.05).It showed sensation abnormal of larynx,lingua,face and limb when the middle and posterior short gyrus,as well as anterior and posterior long gurus,respectively,were stimulated;insula sensory showed anatomy distribution,with different stimulated sensitivities.The sensory function showed parallel distribution with the insular gyrus from the middle short gyrus to posterior long gurus,as laryngeal-lingual-facial (nasal and lips)-limb sensation,and the thresholds of the five insular gurus were (6.0±3.1) mA,(4.7±1.5) mA,(8.0±2.9) mA,(5.1±2.4) mA and (4.5±2.6) mA,respectively,with statistically significant differences (P＜0.05).Conclusions The sensitivity of somatic sensation and visceral sensation of the insula monitored by SEEG is similar,as well as the left and right side.The sensory threshold and sensory fan-shaped distribution play important roles in conforming insular symptoms and location for clinician.

Objective To summarize the common causes and types of circuit failure after vagus nerve stimulator (VNS) implantation,and analyze the available methods of resolving these problems.Methods Three patients with postoperative circuit fault in the 97 patients performed VNS implantation for drug refractory epilepsy in our hospital from October 2011 to January 2014,and three patients with postoperative circuit fault performed surgery in other hospitals at the same period were chosen in this study.The causes of circuit failure of these 6 patients were identified by performing system diagnostics and X-ray evaluation.A revision surgery may be necessary if a broken or damaged lead was suspected.Results In these 6 patients of device failure,two patients were due to the disconnection of the lead from the pulse generator;the lead impedance became normal after re-inserting the existing lead connector pins into the pulse generator following proper lead insertion techniques.Four patients performed lead revision surgery to replace or remove the existing lead;in 3 of them,the helices and associated scar tissues were removed from the vagus nerve under the microscope,and a new set of electrodes was placed;in one of them,the lead was transected as much as possible and the distal portion of the lead was severed at the neck following the removal of pulse generator.There were no complications such as hoarse voice,dyspnea,slow rhythm,subcutaneous hematoma or infection after the revision surgery.Five patients were followed up,indicating the devices work normally.Four patients had obvious improvement,and one patient had no significant improvement after the revision surgery.Conclusions The high lead impedance is the main manifestation of circuit failure after vagus nerve stimulator implantation.Surgical exploration is an effective method to identify and resolve these problems.