Objective:To develop and validate an artificial intelligence (AI) diagnostic model for coronary artery disease based on facial photos.Methods:This study was a cross-sectional study. Patients who were scheduled to undergo coronary angiography (CAG) at Beijing Anzhen Hospital and Beijing Daxing Hospital from August 2022 to November 2023 were included consecutively. Before CAG, facial photos were collected (including four angles: frontal view, left and right 60° profile, and top of the head). Photo datasets were randomly divided into a training set, a validation set (70%), and a testing set (30%). The model was constructed using Masked Autoencoder (MAE) and Vision Transformer (ViT) architectures. Firstly, the model base was pre-training using 2 million facial photos obtained from the publicly available VGGFace dataset, and fine-tuned by the training and validation sets; the model was validated in the test set. In addition, the ResNet architecture was used to process the dataset, and its outputs were compared with those of the models based on MAE and ViT. In the test set, the area under the operating characteristic curve ( AUC) of the AI model was calculated using CAG results as the gold standard. Results:A total of 5 974 participants aged 61 (54, 67) years were included, including 4 179 males (70.0%), with a total of 84 964 facial photos. There were 79 140 facial photos in the training and validation sets, with 3 822 patients with coronary artery disease; there were 5 824 facial photos in the test set, with 239 patients with coronary artery disease. The AUC value of the MAE and ViT model initialized with pre-training model weights was 0.841 and 0.824, respectively. The AUC of the ResNet model initialized with random weights was 0.810, while the AUC of the ResNet model initialized with pre-training model weights was 0.816. Conclusion:The AI model based on facial photos showes good diagnostic performance for coronary artery disease and holds promise for further application in early diagnosis.

Objective:To explore the specific role and molecular mechanism of octamer-binding transcription factor 4 (Oct4) in promoting the progression of esophageal squamous cell carcinoma and radioresistance.Methods:The Gene Expression Profile Data Dynamic Analysis (GEPIA) database was used to analyze the expression differences of the Oct4 gene in different types of tumor tissues and their corresponding adjacent normal tissues. The clinical data and surgical resection tissue specimens of 196 patients with esophageal squamous cell carcinoma who received surgery combined with radiotherapy at Henan Provincial Chest Hospital from January 2013 to May 2022 were collected. Immunohistochemistry was used to detect the expression of Oct4 protein in the tumor and adjacent tissues. The lentiviral packaging system was used to construct esophageal squamous cell carcinoma cell lines that up-regulated or down-regulated Oct4. The cell counting kit 8 (CCK-8) was used to detect the cell proliferation ability, the scratch test was used to detect the cell migration ability, and the clone formation test was used to detect the cell radiosensitivity. Immunofluorescence experiment was used to detect DNA damage level, and Western blot was used to detect the expressions of Oct4, human phosphorylated histone (γ-H2AX), E-cadherin, N-cadherin, vimentin, and zinc finger E box binding homology box 1 (ZEB1).Results:The analysis of GEPIA database showed that the expression level of Oct4 mRNA in esophageal carcinoma was higher than that in paracancerous tissues. The expression level of Oct4 protein in tumor tissues was 78.35±1.42, which was higher than that in adjacent tissues (16.27±0.49). The survival time of patients with a high expression of Oct4 was significantly shorter than that of patients with a low expression of Oct4 (25.40 and 47.00 months). Compared with the control group, the proliferation ability of KYSE510 cells in the Oct4 up-regulated group was enhanced after 72-h culture, and the cell migration ability of these cells was also enhanced, with the migration rate being (41.67±1.20)% vs (23.67±1.86)% after 24-h culture. The radiosensitivity of cells in this group decreased, with the radiosensitivity enhancement ratio being 0.69±0.06 vs 1.00±0.02. After radiotherapy, the expressions of γ-H2AX and E-cadherin decreased, while the expressions of ZEB1, vimentin and N-cadherin increased. Compared with the control group, the proliferation ability of KYSE150 cells in the Oct4 down-regulated groups 1 and 2 decreased (absorbance being 2.51±0.17, 2.38±0.16, and 3.33±0.07, respectively, P＜0.01) after 72-h culture, and the migration ability also decreased, with the migration rate being (13.33±0.88)%, (13.00±1.00)%, and (40.33±2.03)%, respectively (all P＜0.001), after 24-h culture. The radiosensitivity was enhanced, with the radiosensitivity enhancement ratio being 1.34±0.11,1.24±0.07, and 1.00±0.02, respectively (all P＜0.05). After radiotherapy, the expressions of γ-H2AX and E-cadherin increased, while the expressions of ZEB1, vimentin and N-cadherin decreased. Compared with the control group, the proliferation ability of KYSE510 cells in the ZEB1 down-regulated group decreased [absorbance being 1.33±0.15 vs 1.81±0.16 ( P=0.002)] after 72-h culture. The radiosensitivity was enhanced, with the radiosensitivity enhancement ratio being 1.37±0.11 vs 1.00±0.01 ( P=0.037), and after radiotherapy the expression of γ-H2AX increased. Conclusion:Oct4 is involved in the regulation of epithelial-mesenchymal transformation of esophageal squamous cell carcinoma, which promotes the proliferation, migration, and radioresistance of esophageal squamous cell carcinoma.

Objective:To explore the specific role and molecular mechanism of octamer-binding transcription factor 4 (Oct4) in promoting the progression of esophageal squamous cell carcinoma and radioresistance.Methods:The Gene Expression Profile Data Dynamic Analysis (GEPIA) database was used to analyze the expression differences of the Oct4 gene in different types of tumor tissues and their corresponding adjacent normal tissues. The clinical data and surgical resection tissue specimens of 196 patients with esophageal squamous cell carcinoma who received surgery combined with radiotherapy at Henan Provincial Chest Hospital from January 2013 to May 2022 were collected. Immunohistochemistry was used to detect the expression of Oct4 protein in the tumor and adjacent tissues. The lentiviral packaging system was used to construct esophageal squamous cell carcinoma cell lines that up-regulated or down-regulated Oct4. The cell counting kit 8 (CCK-8) was used to detect the cell proliferation ability, the scratch test was used to detect the cell migration ability, and the clone formation test was used to detect the cell radiosensitivity. Immunofluorescence experiment was used to detect DNA damage level, and Western blot was used to detect the expressions of Oct4, human phosphorylated histone (γ-H2AX), E-cadherin, N-cadherin, vimentin, and zinc finger E box binding homology box 1 (ZEB1).Results:The analysis of GEPIA database showed that the expression level of Oct4 mRNA in esophageal carcinoma was higher than that in paracancerous tissues. The expression level of Oct4 protein in tumor tissues was 78.35±1.42, which was higher than that in adjacent tissues (16.27±0.49). The survival time of patients with a high expression of Oct4 was significantly shorter than that of patients with a low expression of Oct4 (25.40 and 47.00 months). Compared with the control group, the proliferation ability of KYSE510 cells in the Oct4 up-regulated group was enhanced after 72-h culture, and the cell migration ability of these cells was also enhanced, with the migration rate being (41.67±1.20)% vs (23.67±1.86)% after 24-h culture. The radiosensitivity of cells in this group decreased, with the radiosensitivity enhancement ratio being 0.69±0.06 vs 1.00±0.02. After radiotherapy, the expressions of γ-H2AX and E-cadherin decreased, while the expressions of ZEB1, vimentin and N-cadherin increased. Compared with the control group, the proliferation ability of KYSE150 cells in the Oct4 down-regulated groups 1 and 2 decreased (absorbance being 2.51±0.17, 2.38±0.16, and 3.33±0.07, respectively, P＜0.01) after 72-h culture, and the migration ability also decreased, with the migration rate being (13.33±0.88)%, (13.00±1.00)%, and (40.33±2.03)%, respectively (all P＜0.001), after 24-h culture. The radiosensitivity was enhanced, with the radiosensitivity enhancement ratio being 1.34±0.11,1.24±0.07, and 1.00±0.02, respectively (all P＜0.05). After radiotherapy, the expressions of γ-H2AX and E-cadherin increased, while the expressions of ZEB1, vimentin and N-cadherin decreased. Compared with the control group, the proliferation ability of KYSE510 cells in the ZEB1 down-regulated group decreased [absorbance being 1.33±0.15 vs 1.81±0.16 ( P=0.002)] after 72-h culture. The radiosensitivity was enhanced, with the radiosensitivity enhancement ratio being 1.37±0.11 vs 1.00±0.01 ( P=0.037), and after radiotherapy the expression of γ-H2AX increased. Conclusion:Oct4 is involved in the regulation of epithelial-mesenchymal transformation of esophageal squamous cell carcinoma, which promotes the proliferation, migration, and radioresistance of esophageal squamous cell carcinoma.

The poor stability of the ligustilide (LIG) makes its quantitation in Angelica sinensis (AS) difficult. This study establishes a chemical conversion method for the determination of ligustilide content in AS and proposes a national pharmacopoeia standard. Mechanical agitation and sonication of a powdered AS extract in a methanol/cyprolamine mixture facilitated the stabilization and transformation of ligustilide. Using an external reference HPLC-DAD method, the cyclopropyl-ligustilide (LIGc) content in the mixture could be determined. The content of ligustilide was greater than 1.0% based on 144 AS specimens including 68 obtained from the originally planted areas of Qinghai and Gansu Province; 55 specimens were obtained from Minxian and Weiyuan County medicine markets, and 21 specimens for which the storage period reached or exceeded 1.5 years. According to the Hong Kong Chinese materis medica standards, the content of ligustilide in AS should not be lower than 0.6%. The developed method could also be applied to the quality control of other Chinese medicinal materials (such as Ligusticum chuanxiong) or Chinese patent medicines in which ligustilide is the main component.

Objective:To observe the clinical effect of extracorporeal shock wave treatment in the treatment of functional disorders after a palm crush injury.Methods:Forty patients who had experienced a hand crush injury more than 3 months previously were randomly divided into a control group and a combination group, each of 20. Both groups were given routine joint mobilization, ultrasound treatment, muscle strength training and occupational therapy every day in ten day units for 2 months. The combination group also received extracorporeal shock wave therapy three times a week for the two months. Before the experiment and after one and two months of treatment, both groups′ upper limb functioning was evaluted using the DASH score, grip strength and hand flexibility in the 9-hole wood board test.Results:After 2 months of treatment, significant improvement was observed in all of the measurements with both groups. The average scores of the combination group on all three tests were by then significantly better than the control group′s averages.Conclusions:Adding extracorporeal shock wave therapy to routine rehabilitation can improve the rough and fine functioning of a crushed hand.

With the in-depth research on pressure injury, pressure injury-related pain has gradually attracted attention, but its definition is not uniform yet, and there is a lack of targeted assessment tools. This research systematically searches the Chinese and English literature related to pressure injury-related pain published from 1995 to 2019, and uses Rodgers' evolutionary concept analysis method to systematically analyze the concept, and clarify its defining attributes, causes and consequences. This research also puts forward the attributes of pressure injury-related pain, clarifies related concepts such as chronic wound-related pain and wound-related pain, as well as the concept with typical cases, so as to provide a reference for the management of pressure-related pain.

BACKGROUND:The output of computed tomography (CT) is Digital Imaging and Communications in Medicine (DICOM), whereas the input of three-dimensional (3D) printing is an object Standard Template Library model represented by a triangular mesh. The process of data handing and forrmat conversion are keys to the combination of these two techniques. OBJECTIVE:To explore how to convert CT data into a stereoscopic 3D model efficiently. METHODS:The DICOM in Medicine format data of the patients with femoral fractures were edited and produced by Mimics. We made a 3D model by adjusting the parameters of the 3D printer slicing software, and discussed the significance of 3D model in medical field, especially orthopedics. RESULTS AND CONCLUSION:Mimics software is the bridge to connect two-dimensional CT scan images and 3D images, to create a 3D model by editing the data of DICOM which comes from the CT scanner, with a 3D printing technology. The 3D Model can help doctors for routine clinical diagnosis and treatment, to improve the communication between doctors and patients and the quality of clinical medical teaching. 3D printing also makes medicine more personalized, remote, minimally invasive, and promote the development of medicine to the direction of digital medicine.

BACKGROUND:In the treatment of tibial plateau fractures, because of the variety of fracture, the complexity of anatomical changes, X-ray films or three-dimensional CT scan limited by two-dimensional plane, increases the difficulty in preoperative plan and surgical treatment. The application of three-dimensional (3D) printing technology has attracted attention in the department of orthopedics. OBJECTIVE:To explore the auxiliary role of 3D printing technique in preoperative plan and treatment for tibial plateau fractures. METHODS:Thirty patients with tibial plateau comminuted fractures were enroled in this study and divided into two groups: experimental and control groups, with 15 patients in each group. In the experimental group, patients underwent 3D CT scan, which was stored in DICOM format, and processed by Mimics software. Data were converted into STL format, entered 3D printer, and a 1:1 entity size of the fracture model was made, in accordance with repair plan of 3D fracture model. Operation time and intraoperative blood loss were compared between the two groups. At 12 months after treatment, their outcomes were assessed using Rasmussen evaluation criteria. RESULTS AND CONCLUSION: The 3D printing fracture models of 1:1 ratio identified fracture type and made a repair program before surgery in the experimental group. Operation time and intraoperative blood loss were significantly less in the experimental group than in the control group (P < 0.05). After surgery, patients were folowed up for 12 to 18 months. The healing time was 3-5 months, averagely 4.3 months. At 12 months after treatment, the Rasmussen evaluation criteria results showed that the excelent and good rate was significantly higher in the experimental group than in the control group (P < 0.05). These results suggest that the fracture model of 3D can help to make the operation plan. The treatment of tibial plateau fractures is more precise, personalized and visual.

BACKGROUND:As a noticeable tissue engineering material of polyhy droxyalka noates family, poly (3-hydroxybutyrate-co-4-hydroxybutyrate)(P3HB4HB) exhibitsgood biocompatibility, adhesion and mechanicalproperties, presenting aextensive application future in tissue-engineered research.
OBJECTIVE:To investigate the biocompat ibilityin vitroand ectopic osteogenic differentiationin vivoof P3HB4HB and human bone marrow mesenchymal stem cels.
METHODS:Passage 5human bone marrow mesenchymal stem cels transplanted ontothe three-dimensional P3HB4HB scaffoldwereincubated with osteogenic induction medium (test group)or with no osteogenic induction(control group), respectively. After 5-day incubation, thecelgrowth was assessed by acridine orange staining and scanning electron microscopy; after14-day incubation, both kinds of cel-scaffold composites were subcutaneously implanted into the nude mice. At 16 weeks after implantation, the cel-scaffold composites were removed to observeectopic osteogenic differentiationin vivousing hematoxylin-eosin staining, von Kossa staining and colagen type I immunohistochemical staining.
RESULTS AND CONCLUSION:Acridine orange staining showed that cels adhered wel on the surface of the scaffold;under thescanning electron microscope, induced celsgrew wel on the P3HB4HB scaffold and produced abundant extracelular matrixes. In addition, at 16 weeks after implantation, there were osteoidtissues in the test group, positive for von Kossa staining as wel as colagen type I immunohistochemical staining;furthermore, hematoxylin-eosin staining showednumerous osteoblasts and bone lacunas. In contrast, no bone tissues appeared in the control group. To conclude, P3HB4HB is a suitable material for bone tissue engineering.

Objective To study the clinical,pathological features and treatment of metastatic breast cancer with triple negative breast cancer(TNBC) and its relationship with disease free survival.Methods One hundred and fifty-eight cases of TNBC patients who were treated in the First Affiliated Hospital of Zhengzhou University and the Chinese Medicine Hospital of Changge from January 2004 to January 2009 were selected as the research objects.All patients received operation and radiotherapy,the relationship between the clinical characteristics,pathological features and treatment with 5,3 year survival rate,and the recurrence and metastasis of patient were analyzed.Results In clinical stage Ⅲ period,the 3 years survival rate was 46.51％ (20/43),5years survival rate was 37.21％ (16/43),all significantly lower than in the phase Ⅰ and Ⅱ (91.53％ (54/59) and 76.27 ％ (45/59);87.50％ (49/56) and 71.43 ％ (40/56)),and the differences were statistically significant (x2=25.306,15.787,19.348,11.592;P＜0.001).With lymph node metastasis,the 3 years survival rate was 66.00％ (33/50),5 years survival rate was 50.00％ (25/50),significantly lower than that without lymph node metastasis(83.33％ (90/108),70.37％ (76/108)),the difference was statistically significant (x2=5.954,6.150;P＜0.05).In pathological grade Ⅲ,the 3 years survival rate was 65.67％(44/67),5 years survival rate was 43.28％ (29/67),significantly lower than that of grade Ⅰ (92.86％ (26/28),85.71％ (24/28)) and grade Ⅱ (84.13％ (53/63),76.19％ (48/63)),the difference was statistically significant(x2=7.527,14.414,5.839,14.560;P＜0.05).The 3 year survival rate of radiotherapy group was significantly higher than that in non radiotherapy group,the difference was statistically significant (81.58％ (31/38) vs.57.69％ (15/26);x2=4.357,P＜0.05).Patients with metastatic sites were lung,liver,brain,bone and supraclavicular lymph nodes,the median survival time after the transfer all more than 2 years.Conclusion TNBC is a special type of breast cancer that is difficult to treat,no consensus has been reached on the clinical treatment plan.Breast conserving surgery also has certain application value,radiotherapy only can increase the 3 year survival rate.The clinical stage and pathological grade are the influence factors of prognosis.