Objective To evaluate the application of three deep learning algorithms in automatic segmentation of clinical target volumes (CTVs) in high-dose-rate brachytherapy after surgery for endometrial carcinoma. Methods A dataset comprising computed tomography scans from 306 post-surgery patients with endometrial carcinoma was divided into three subsets: 246 cases for training, 30 cases for validation, and 30 cases for testing. Three deep convolutional neural network models, 3D U-Net, 3D Res U-Net, and V-Net, were compared for CTV segmentation. Several commonly used quantitative metrics were employed, i.e., Dice similarity coefficient, Hausdorff distance, 95th percentile of Hausdorff distance, and Intersection over Union. Results During the testing phase, CTV segmentation with 3D U-Net, 3D Res U-Net, and V-Net showed a mean Dice similarity coefficient of 0.90 ± 0.07, 0.95 ± 0.06, and 0.95 ± 0.06, a mean Hausdorff distance of 2.51 ± 1.70, 0.96 ± 1.01, and 0.98 ± 0.95 mm, a mean 95th percentile of Hausdorff distance of 1.33 ± 1.02, 0.65 ± 0.91, and 0.40 ± 0.72 mm, and a mean Intersection over Union of 0.85 ± 0.11, 0.91 ± 0.09, and 0.92 ± 0.09, respectively. Segmentation based on V-Net was similarly to that performed by experienced radiation oncologists. The CTV segmentation time was < 3.2 s, which could save the work time of clinicians. Conclusion V-Net is better than other models in CTV segmentation as indicated by quantitative metrics and clinician assessment. Additionally, the method is highly consistent with the ground truth, reducing inter-doctor variability and treatment time.

Hyperpolarization-activated cyclic nucleotide-gated(HCN)channels are widely expressed in the central and peripheral nervous systems.They can generate hyperpolarization-activated current(Ih)that regulates the resting membrane potential and excitability of neurons.Furthermore,it can affect the precise processing and con-duction of hearing,which plays a crucial role in the accurate analysis of temporal information.Therefore,through the review of HCN channel structure and distribution,as well as electrophysiological effects,the role and mecha-nism of HCN channels in the auditory pathways of the normal and unilateral or bilateral deafness patients will be fur-ther investigated.

Objective:To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on weight loss in patients with different degrees of obesity.Methods:A retrospective analysis was performed on 152 patients with obesity who underwent LSG in Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from March 2019 to May 2022, including 119 females (78.3%) and 33 males (21.7%), with a mean age of (30.9±7.9) years (ranging from 18 to 58 years). The body mass index (BMI) was 30.0-34.9 kg/m 2, 35.0-39.9 kg/m 2 and ≥40.0 kg/m 2 in Ⅰ, Ⅱ and Ⅲ objesity groups respectively ( n=38, 57, 57). The body measurements, biochemical indexes, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) were collected and analyzed before and after surgery at 1, 3, 6, 12 months. Statistical analysis was conducted using SPSS 22.0 software. Results:LSG was successfully implemented in 152 patients. Body weight, BMI, waist circumference, hip circumference, waist-to-hip ratio, liver function, blood glucose and lipid parameters all decreased at each time point of postoperative follow-up, while uric acid increased at 1 month and decreased at 3, 6 and 12 months after surgery and then gradually decreased. At 12 months after surgery, the body weight was (75.9±17.0) kg ( t=15.14, P<0.001), BMI (26.2±3.7) kg/m 2 ( t=14.44, P<0.001), waist circumference (89.0±10.7) cm ( t=9.20, P<0.001), hip circumference 100.6±7.6 cm ( t=12.67, P<0.001), alanine aminotransferase (18.2±16.6) μ/L ( t=2.83, P=0.018), aspartate aminotransferase (15.2±14.2) μ/L ( t=2.84, P=0.018), fasting plasma glucose (4.6±0.5) mmol/L ( t=2.01, P=0.026), triglyceride 1.1±0.5 mmol/L ( t=3.71, P=0.005) and uric acid 340.2±102.7 μmol/L ( t=4.46, P=0.001), all were lower than those before surgery with statistical significance. At 6 months after surgery, the %EWL in Ⅰ, Ⅱ and Ⅲ obesity groups was (92.7±35.5) %, (86.1±16.0) % and (67.5±14.0) % respectively, with statistical significance among the 3 groups ( F=5.38, P=0.010). The %TWL was (20.5±7.4) %, (28.5±5.2) % and (28.9±6.1) % in the three groups respectively, and the overall difference was statistically significant ( F=3.50, P=0.043). At 1 year after surgery, there was no significant difference in %EWL and %TWL among the 3 groups. Conclusions:LSG was effective in treating simple obesity, with improvements of body weight, waist circumference, hip circumference, liver function, blood glucose and lipid and uric acid. In the first 6 months after surgery, %EWL in patients with class Ⅰ obesity was higher than that in patients with class Ⅲ obesity, achieving relatively better weight loss. However patients with class Ⅲ obesity also experienced significant weight loss until 1 year after surgery.

Objective:To investigate the species and number of glial cell clusters, main signaling pathway and progression of glial cell clusters after peripheral nerve injury (PNI) in rats using single-cell RNA sequencing (scRNA-seq).Methods:Twenty-seven SD rats were randomly divided into sham-operated group, group of 3 d after PNI and group of 7 d after PNI ( n=9). Thrice squeezing the right sciatic nerves in the group of 3 d after PNI and group of 7 d after PNI and no damage in the sham-operated group were performed. Species and number of glial cell clusters in the right sciatic nerve samples were detected by scRNA-seq. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to analyze the signal pathway enriched by differentially expressed genes (DEGs) of glial cells in the right sciatic nerve samples. Pseudo time analysis was used to simulate the progression of glial cell clusters in the right sciatic nerve samples. Results:(1) ScRNA-seq revealed a total of 1 609 glial cells (mainly cluster 6 [ n=1 388]) in the sciatic nerve samples of sham-operated group; 6 176 glial cells were observed in the sciatic nerve samples of group of 3 d after PNI, mainly cluster 2 ( n=3 124) and cluster 3 ( n=959); 8 975 glial cells were observed in the sciatic nerve samples of group of 7 d after PNI, mainly cluster 1 ( n=3 071), cluster 4 ( n=1 696), and cluster 5 ( n=1 389). (2) GO and KEGG analysis showed that compared with those in the sham-operated group, biological processes such as protein translation, cadherin binding and ribosome composition were up-regulated in glial cells in the group of 3 d after PNI and group of 7 d after PNI. Compared with those in the group of 3 d after PNI, glial cells enriched in biological processes such as axonal regeneration, myelination and focal adhesion, and in upregulated mitogen activated protein kinase (MAPK) signaling pathway and phosphoinositide 3-kinase (PI3K)-protein kinase B (PKB) signaling pathway in the group of 7 d after PNI. (3) Pseudo time analysis showed that glial cells in the sciatic nerve samples were mainly cluster 6 (marker genes: Atp1a2 and Sparcl1) in the sham-operated group, progressed into cluster 2 (marker genes: Mapt and Slc7a11) and cluster 3 (marker genes: Esco2 and Neil3) mainly in the group of 3 d after PNI, and progressed into cluster 1 (marker genes: Bcas1 and Prx), cluster 4 (marker genes: Ccn2 and Gap43), and cluster 5 (marker genes: Cd24 and Atxn1) mainly in the group of 7 d after PNI. Conclusion:In rats after PNI, glial cells can up-regulate MAPK signaling pathway and PI3K-PKB signaling pathway; with prolonged injury time, glial cells can progress into clusters with marker genes Bcas1, Prx, Cd24 and Atxn1 mainly.

Objective:To reveal the molecular characteristics of mononuclear phagocytes (MPs) in rat model of peripheral nerve injury (PNI) using single-cell RNA sequencing (scRNA-seq) technology that would provide the developmental changes and major biological process involved in the function of MPs after PNI.Methods:Twenty-seven male SD rats (200-300 g in weight) were selected from the Department of Hand and Foot Microscopy and Wound Repair Surgery, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University) and the Department of Orthopaedics of First Affiliated Hospital of Zhengzhou University from July 2023 to December 2023. The rats were divided into a Sham operation group (Sham group), a 3 days post crush group (3 dpc group) and a 7 days post crush group (7 dpc group), following the randomised table method with 9 rats per group. After 7 days of environmental acclimatisation, the 3 dpc group and 7 dpc group were subjected to have the right sciatic nerve crushed in order to create a model of crush injury. And as a control group, the Sham group was subjected to Sham surgery only. Nine right sciatic nerves of rats were collected from each group at the corresponding time pints. Single-cell isolation was performed on the 10X Genomics platform. ScRNA-seq libraries were constructed using the Gel Bead Kit V3 and the libraries were sequenced using an Illumina Novaseq 6000 sequencer. Dimensionality reduction was performed using Principal Component Analysis and T-Distributed Stochastic Neighbor Embedding to visualise and explore the cellular heterogeneity within the dataset. Nine distinct cell clusters and their corresponding marker genes were identified based on the dimensionality-reduced data. Differential gene expression analysis was then performed to identify differentially expressed genes (DEGs) in MPs between different groups. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed to uncover the biological processes and pathways based on the DEGs. Monocle program for pseudo-time analysis was used to infer the developmental trajectory of MPs after injury.Results:A total of 19 054 cells were obtained by sequencing, and the results showed that the proportion of MPs in peripheral nerves was significantly up-regulated after PNI, and MPs were classified into 9 cellular subgroups based on the clustering analysis of the scRNA-seq data, which were Cluster 1 (3 398 cells), Cluster 2 (3 388 cells), Cluster 3 (3 262 cells), Cluster 4 (2 825 cells), Cluster 5 (2 753 cells), Cluster 6 (1 894 cells), Cluster 7 (648 cells), Cluster 8 (492 cells) and Cluster 9 (394 cells), respectively. Based on the expression of different cell subpopulation markers, MPs in the Sham group, 3 dpc group and 7 dpc group of sciatic nerves were classified into 9 cell clusters and the distributions of different MPs clusters in the 9 sciatic nerve samples were identified, among which, the Sham group had the lowest number of MPs cells in the sciatic nerve samples (a total of 2 719 cells) and the clusters were mainly dominated by clusters 5 (1 119 cells) and clusters 6 (1 240 cells). The 3 dpc group had the highest number of MPs cells (9 760 cells in total) and the clusters were mainly dominated by cluster 2 (1 760 cells), cluster 3 (3 130 cells) and cluster 4 (2 300 cells). The MPs (6 575 cells in total) in the 7 dpc group were mainly dominated by cluster 1 (2 406 cells) and cluster 2 (1 628 cells). Compared with the Sham group, the GO and KEGG annotations of the DEGs were significantly upregulated in the 3 dpc group, indicating that MPs in the rat sciatic nerves would have the ability to bind to extracellular molecules and remove debris from the injury site at 3 days post-injury, and the 7 dpc group would have the ability to activate the signalling pathways related to nerve repair. The proposed time-series analysis revealed that, in the uninjured condition, the MPs were mainly in the cluster 5 (Ccl17 +Cd80 +) and cluster 6 (Fcmr +Slc9a9 +). At 3 days post-injury, MPs developed into cell types dominated by cluster 2 (Cd8b +Meis3 +), cluster 3 (Il10 +Cd163 +) and cluster 4 (Ccl24 +Prg4 +). At 7 days post-injury, the effector state of cluster 2 among the main cell types of MPs was still maintained but the other parts had developed into cluster 1 (Hspa1b +Apobec1 +) related phenotypes. Conclusion:The molecular characteristics of MPs in the peripheral nerve revealed through scRNA-seq data provide valuable insights into the role of MPs in mediating inflammation and neural regeneration after PNI.

ObjectiveTo summarize the research progress of mammalian target of rapamycin （mTOR） pathway regulated by traditional Chinese medicine（TCM） and provide reference for visualization and quantitative analysis of related research based on multiple software linkage. MethodLiterature related to TCM regulation of mTOR pathway in Web of Science was taken as the research object. Citespace，VOSviewer，and carrort² were used for biliometric analysis and visualization of the literature. ResultA total of 245 papers that met the requirements were retrieved，and the visual analysis showed that the papers presented a fluctuating increase year by year after 2010，and numerous research results emerged in 2018. China had the most publications. Institutions with a large number of publications were mainly in Beijing and Shanghai，and most of the regional cooperation was centered in Beijing and Nanjing. According to the research direction and focus，it was found that the intervention of TCM in mTOR pathway in recent years mainly concentrated on the anti-tumor，anti-apoptotic and anti-inflammatory aspects， and TCM interfered with mTOR pathway to regulate cell apoptosis，autophagy，proliferation，and death. AMP-activated protein kinase （AMPK） and phosphatidylinositol 3-kinases（PI3K）/protein kinase B（Akt）/mTOR pathway were the current and future research hotspots. ConclusionResearch on the regulation of mTOR pathway by TCM had a good prospect，and the in-depth study might provide new ideas and guidance for the treatment of cardiovascular diseases，tumor and other major diseases.

Objective:To explore the effect of sciatic nerve derived exosomes(SN-EXO) on axon regeneration and functional recovery after peripheral nerve injury(PNI).Methods:From March 2021 to October 2022, the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University studied the effect of SN-EXO on the proliferation of Schwann cells(SCs) through EdU cell proliferation experiment. Twenty-one healthy male SD rats were randomly divided into 3 groups of sham operation, peripheral nerve injury(PNI) and SN-EXO treatment, with 7 rats in each group. The right sciatic nerves of rat models in sham group were exposed without injury. In the rat in PNI group and SN-EXO treatment group, PBS and SN-EXO were injected under the epineurium of right sciatic nerves following sciatic nerve crush. Sciatic nerve function index(SFI) was performed at 28 days after operation, and then sacrificed. Right sciatic nerves were removed for further exploration of nerve regeneration. The histopathological changes and axon arrangement of sciatic nerves were evaluated by HE staining. Regeneration efficiency of neurofilaments and SCs were obserred by NF200 and S100β double staining of sciatic nerve. The data obtained were statistically analyzed, and P<0.05 was statistically significant. Results:It was found that SN-EXO can significantly enhance the proliferation ability of SCs, with statistically significant difference( P<0.05). SFI in SN-EXO treatment group and PNI group were(-27.65±4.36) and(-57.33±7.49), respectively, and the difference was statistically significant( P<0.05). Axons in SN-EXO treatment group were arranged more closely and orderly than those in the PNI group at 28 days after operation, and there were less injury induced axon disintegration and vacuolation. Immunofluorescence assay indicated that NF200 and S100β fluorescence intensity in SN-EXO treatment group was significantly higher than that in the PNI group, and the difference was statistically significant( P<0.05). Conclusion:SN-EXO could enhance the proliferation of SCs to promote axon regeneration following peripheral nerve injury.

Objective:To evaluate the efficacy and safety of nonsurgical methods in early postnatal correction of congenital auricle malformation.Methods:The clinical trials regarding non-surgical treatment for congenital ear deformity published before May 2021 were searched in databases of Cochrane Library, PubMed, Medline, CNKI, VIP and Wanfang. The information of included studies was extracted. The Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 15 trials were included, involving 1 349 patients. The Meta-analysis results showed that the effect of the group <6 weeks was better than the group over 6 weeks ( OR=4.67, 95% CI: 3.21, 6.78, Z=8.09, P<0.001); The complications incidence of the group < 6 weeks was lower than the group over 6 weeks ( OR=0.27, 95% CI: 0.08, 0.88, Z=2.18, P=0.03); The correction time required of the group <6 weeks was shorter than the group over 6 weeks ( MD=-11.81, 95% CI: -18.36, -5.26, Z=3.54, P=0.001). Conclusions:Non-surgical correction of congenital ear malformation within 6 weeks after birth has better efficacy and safety.

  Objective  To discuss the significance of genetic diagnosis of children with syndromic hearing loss by using whole-exome sequencing.  Methods  The clinical data of 34 children with sensorineural hearing loss were collected and the whole exons of genome of the children and their parents were sequenced and analyzed.  Results  Genetic causative gene and mutations have been identified in 19 children, including 4 genes (HARS2, USH2A, GATA3, MITF) related to rare syndromic hearing loss. Fifteen children were diagnosed with non-syndromic hearing loss related gene, including 8 cases with GJB2 mutation, 5 cases with SLC26A4 mutation and 2 cases with MYO15A mutation. Mutations of c.435_437del(p.K147del) and c.1403G > C (p.G468A) in gene HARS2, c.11389+1del in gene USH2A, c.1327delA(p.M443Wfs*33) in gene GATA3, c.627C > A(p.C209X) in gene MITF and c.8033_8057delinsG(p.N2678_D2686delinsS) in gene MYO15A were first reported.  Conclusions  Whole-exome sequencing helps the accurate diagnosis of causes of hearing loss, especially for the rare syndromic hearing loss with atypical clinical manifestations. Information from genetic testing may highlight further recommended exams of structure and functions of related organs.

Objective:To analyze the radiological protection situation in the workplace of medical X-ray diagnostic equipment in primary medical institutions in south Xinjiang Uygur Autonomous Region, and then put forward necessary measures and suggestions.Methods:In accordance with the national medical radiation protection monitoring program and the requirements of relevant standards for radiological health, medical X-ray diagnostic equipment in radialogical diagnosis and treatment institutions was tested selectively for workplace radiological protection, with the result statistically analyzed.Results:From 2018 to 2021, radiological protection test was conducted for 84 workplaces in 15 radiological diagnosis and treatment institutions in 4 districts of south Xinjiang, with a pass rate of 98.8%, which was consistent with the mainland including the eastern and central regions in the country.Conclusions:Based on the current situation in radiological diagnosis and treatment institutions on medical radiation protection in south Xinjiang, it is recommended to strengthen the supervision and management of radiological diagnosis and treatment equipment, improve the testing and technical capabilities of the local medical radiation monitoring technical teams and raise the level of radiological health work in the south Xinjiang.