ObjectiveTo investigate the effect of Gualou Xiebai Banxiatang on cardiac function and myocardial histopathological changes in rats with ischemic myocardial injury， and to observe the effect of myocardial microvascular density （MVD）， phosphatidylinositol 3-kinase （PI3K）， mammalian target of rapamycin （mTOR）， hypoxia-inducible factor-1 alpha （HIF-1α）， and vascular endothelial growth factor （VEGF） signaling pathways on myocardial microangiogenesis. MethodSeventy male SD rats were randomly selected， with six rats in the normal group. The remaining rats were fed a high-fat diet and injected with isoproterenol hydrochloride （ISO，80 mg·kg^-1·d^-1， 2 d） to induce a hyperlipidemia-based ischemic heart disease model. After successful modeling， the rats were randomly divided into the model group， high， medium， and low dose groups of Gualou Xiebai Banxiatang， and the metoprolol group. The high， medium， and low dose groups of Gualou Xiebai Banxiatang were given Gualou Xiebai Banxiatang at 10.42， 5.21， 2.61 g·kg^-1·d^-1， respectively， while the metoprolol group was given metoprolol at 2.6 mg·kg^-1·d^-1. Both the normal and model groups were given an equivalent volume of physiological saline for 28 days. After the intervention， relevant tests were conducted， and serum was collected to measure heart function-related indicators. Hematoxylin-eosin （HE） and Masson staining were performed on ventricular tissue to observe pathological changes under a light microscope. Immunohistochemistry （IHC） was used to detect the positive expression of platelet endothelial cell adhesion molecule （CD31）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the expression of N-terminal pro-brain natriuretic peptide （NT-proBNP） and VEGF. Western blot was used to detect the protein expression levels of PI3K/mTOR/HIF-1α/VEGF. ResultCompared with the normal group， the model group showed significantly increased serum levels of LDH， CK， CK-MB， NT-proBNP， and VEGF （P<0.01）， significantly increased collagen volume fraction （CVF） （P<0.01）， significantly decreased MVD （P<0.01）， and elevated protein expression levels of PI3K， mTOR， HIF-1α， and VEGF （P<0.05， P<0.01）. Compared with the model group， the metoprolol group had significantly lower serum levels of LDH， CK， CK-MB， and NT-proBNP （P<0.01）， significantly higher VEGF levels （P<0.01）， significantly decreased CVF （P<0.01）， significantly increased MVD （P<0.01）， and significantly increased protein expression levels of PI3K， mTOR， and VEGF （P<0.01）， with no statistically significant change in HIF-1α protein expression. Compared with the model group， the high and medium dose groups of Gualou Xiebai Banxiatang had decreased serum levels of LDH， CK， CK-MB， and NT-proBNP （P<0.05， P<0.01）， increased VEGF levels （P<0.05， P<0.01）， significantly reduced CVF （P<0.01）， increased MVD （P<0.05， P<0.01）， and significantly increased protein levels of PI3K， mTOR， HIF-1α， and VEGF （P<0.01）. In the low dose group of Gualou Xiebai Banxiatang， compared with the model group， serum levels of LDH and NT-proBNP were decreased （P<0.05）， VEGF was increased （P<0.05）. Moreover， CVF was decreased （P<0.05）， and the protein expression levels of PI3K， mTOR， HIF-1α， and VEGF were significantly increased （P<0.01）. ConclusionGualou Xiebai Banxiatang can improve cardiac function， reduce myocardial pathological damage， enhance endothelial cell function， promote myocardial microvascular formation， and upregulate the expression of PI3K， mTOR， HIF-1α， and VEGF proteins in myocardial tissue in rats with ischemic myocardial injury.

Objective To explore the effectiveness of using Excel sheets combined with QR codes for precision naviga-tion and location management of sterile instrument rooms in the operating room.Methods The study focused on the location management of nearly 1,000 sterile instruments in three sterile instrument rooms of our hospital.Instruments from July to Septem-ber 2023 were used as the control group,employing traditional location management methods.Instruments from October to De-cember 2023 were used as the observation group,applying Excel sheets and QR codes for precise navigation and location manage-ment.Results The time taken by new nurses and interns to find and retrieve sterile instruments decreased from(4.61±0.32 min)to(1.41±0.15 min).The accuracy of retrieving sterile instruments increased from 83.33％to 98.33％.The compliance rate for location management of sterile instruments improved from 75％to 100％.Nurse satisfaction increased from 81.67％to 96.67％,with significant differences observed(P＜0.05).Conclusion The application of Excel sheets combined with QR codes for precision navigation and location management of sterile instrument rooms in the operating room effectively reduces re-trieval time for sterile instruments,decreases error rates,optimizes management processes,enhances work efficiency,avoids sur-gical delays,ensures patient safety,minimizes conflicts between medical staff and patients,and increases nurse satisfaction.This approach is worthy of clinical promotion and application.

Objective:To investigate the clinical outcomes of minimally invasive lateral lumbar interbody fusion (LLIF) and the necessity to perform LLIF plus posterior direct decompression in the treatment of severe degenerative lumbar spinal stenosis (DLSS).Methods:In this prospective randomized, controlled trial, we assigned 71 patients, who were 50 to 80 years old, and diagnosed with severe DLSS (Schizas Classification grade C on magnetic resonance imaging), in a 1∶1 ratio to undergo either one-stage LLIF plus posterior internal fixation (treatment group) or CLIF plus posterior internal fixation with laminectomy (control group). Demographic and perioperative data were collected and compared. The clinical outcome measures included Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) score as well as visual analogue scale (VAS). Patients were followed up for at least 1 year.Results:The treatment group included 36 patients with 46 surgical levels, while the control group included 35 patients with 46 surgical levels. The baseline demographic data of the 2 groups were equivalent in preoperative central canal areas, spinal canal anteroposterior diameter, disc height, ODI, ZCQ score for symptom severity and physical function, as well as VAS scores for back and leg pain. The mean operative time, blood loss, drainage volume and hospital stay of the treatment group are significantly less than the control group (157.2±29.1 min vs. 180.6±26.8 min, 75.6±39.1 ml vs. 108.6±43.3 ml, 136.9±73.9 ml vs. 220.5±121.3 ml, 5.3±1.1 d vs. 6.6±2.3 d). There were 2 cases with dura tear and 1 case with wound infection in control group. Thus, the surgical trauma and complications of the control group were more than the treatment group. At 1-year follow-up, the mean ODI score of treatment group improved from 42.24%±10.70% preoperatively to 18.21%±11.49%, the mean ZCQ symptom severity from 2.89±0.38 to 1.61±0.41, the mean ZCQ physical function from 2.31±0.45 to 1.50±0.37, the mean VAS for back from 5.56±1.19 to 1.97±1.13 and the mean VAS for leg from 4.44±1.81 to 0.94±1.26. At 1-year follow-up, the mean ODI score of the control group improved from 43.65%±14.93% preoperatively to 17.36%±12.15%, the mean ZCQ symptom severity from 2.92±0.52 to 1.65±0.39, the mean ZCQ physical function from 2.37±0.52 to 1.55±0.39, the mean VAS for back from 5.63±1.40 to 2.34±1.47, and the mean VAS for leg from 4.37±2.14 to 0.83±1.20. The ZCQ satisfactory score of both groups were not significant different (1.25±0.45 vs. 1.26±0.43, t=0.07, P=0.944). The mean improvement rate of both groups for ODI, ZCQ symptom severity, ZCQ physical function, VAS back and VAS leg at 1-year follow-up were not significant different (55.43%±27.74% vs. 58.36%±25.06%, 43.07%±17.22% vs. 42.66%±12.95%, 32.25%±23.65% vs. 31.71%±23.24%, 62.65%±21.25% vs. 58.37%±22.44%, 78.94%±26.41% vs. 85.45%±20.53%). One adjacent segment disease was found in each group at 1 year follow-up. Conclusion:CLIF+ posterior internal fixation in the treatment of Schizas Grade C DLSS has satisfactory clinical outcome at 1-year follow-up. Laminectomy increases surgical trauma, but does not significantly improve the clinical outcome at 1-year follow-up.

Objective:To analyze and summarize the clinical and genetic features of Noonan syndrome (NS) caused by mutations in the leucine zipper-like transcription regulator 1 ( LZTR1) gene. Methods:The retrospective study analyzed a patient who was examined at the Center of Prenatal and Hereditary Disease Diagnosis, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University in January 2021 because of fetal nuchal translucency thickening and a previous history of problematic pregnancies. Subsequently, the patient was diagnosed with Noonan syndrome (NS) through whole exome sequencing. Using keywords such as "Noonan syndrome," "Leucine zipper-like transcription regulator 1", and " LZTR1", clinical and genetic characteristics of NS derived from LZTR1 mutations were summarized by extracting relevant literature from China National Knowledge Infrastructure, Wanfang Database, Yiigle, PubMed and Web of Science, covering from January 2013 to October 2022. Descriptive analysis was applied to the data. Results:(1) Case report: WES and Sanger sequencing showed the existence of the biallelic variants of LZTR1 gene c.842C>T and c.2248G>A in the fetus (Ⅱ-3) and the proband (Ⅱ-2) that inherited from the father and the mother, respectively. Based on the typical special facial appearance and short stature in the proband indicative of NS, the fetus and the proband were diagnosed with autosomal recessive inheritance (AR) NS. The pregnant woman terminated her pregnancy at 22 weeks due to severe edema of the fetus. At the age of three, the proband exhibited typical craniofacial features and short stature characteristics of NS when presented to our hospital. The proband received regular follow-ups in the pediatrics department of other hospitals, where recombinant human growth hormone was used to improve his height. He attended kindergarten at age four and can communicate and play with other children normally. (2) Literature review: 95 cases of NS associated with LZTR1 mutations have been retrieved and included. When including the fetus and the proband of this case, the total reached 97 cases, involving 79 different mutation sites. Forty-three cases (44.3%) were AR, and 54 (55.7%) were autosomal dominant inheritance (AD). Missense mutation was the most prevalent type of mutation, whereas nonsense mutation and frameshift mutation were more common in biallelic variants. Across all cases, the clinical manifestations encompassed multiple systems, primarily characterized by craniofacial dysmorphia, skeletal deformities, heart defects, and short stature. Developmental delay, learning disabilities, and mental retardation of varying degrees may accompany these symptoms. Eighteen cases described antenatal phenotypes, with 16 of them reporting biallelic AR variants. Ultrasound findings of 18 prenatal cases revealed 11 cases of fetal NT thickening, seven cases of cystic hygroma, four cases of fetal pericardium or pleural effusion, two cases of severe fetal edema, and 11 cases of cardiovascular defects. Conclusions:NS induced by LZTR1 mutations is an autosomal dominant or recessive inherited genetic syndrome with a broad spectrum of clinical phenotypes. The severity of the disease varies among children with the same genotype. NS should be considered when prenatal ultrasound indicates nonspecific manifestations, such as fetal NT thickening, cervical lymphatic hydrops, polyhydramnios, fetal edema, and congenital heart defects. Prenatal identification is crucial for evaluating the prognosis of children and assisting families in making clinical decisions.

Objective:To explore the clinical effect of the application of intraoperative psoas major intramuscular block therapy on the complications related to the approach after multi-segmental crenel lumbar interbody fusion (CLIF).Methods:All of 68 degenerative lumbar scoliosis patients who had received multi-segmental crenel lumbar interbody fusion during January 2020 and June 2020 were retrospectively reviewed. Patients were divided into two groups according to whether the psoas major muscle was treated with block therapy during the operation. The psoas muscle inblock group were filled with gel sponge infiltrated with a mixture of Betamethasone and lidocaine for local block therapy before closing the incision while that in the control group were not filled with gel sponge. There were 33 patients in the control group, 7 males and 26 females with an average of 65.8±7.1 years old (range: 54-81 years old); 35 cases in the block group, 9 males and 26 females with an average of 68.0±6.5 years old (range: 54-85 years old). The complications related to the approach (mainly includes pain, numbness in the front of the thigh, as well as psoas major, quadriceps muscle strength) were recorded respectively 1 day, 1 week, 1 month and 3 months after surgery. The main indicators of outcome including visual analog scale (VAS) of pain, the visual analog scale (VAS) of numbness, muscle strength of psoas major and quadriceps femoris, and the incidence of complications related to the approach were compared between the two groups of patients at different time points after surgery. The clinical outcomes were assessed using the Oswestry disability index (ODI), VAS for low back pain. The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (sagittal vertical axis, SVA).Results:There were no significant differences in age, gender, body mass index (BMI), number of fusion segments, operation time, and intraoperative blood loss between the two groups. The incidence of approach-related complications was 17.1% in the block group and 39.4% in the control group, with statistically significant difference between the two groups ( χ2=4.177, P=0.041). The incidence of postoperative pain, numbness in the front of the thighs, and muscle strength of psoas major in the block group (11.4%, 14.3%) were lower than those in the control group (33.3%, 36.4%) ( χ2=4.740, P=0.029; χ2=4.416, P=0.036). And for numbness in the front of thigh, the block group (14.3) was lower than control group (21.2%), but no significant difference was shown between two groups ( χ2=0.561, P=0.454). However, there was no quadriceps weakness in either group. The VAS scores of painof the block group were lower than those of the control group at 1 day, 1 week, and 1 month after surgery, and the difference was statistically significant ( t=2.220, P=0.031; t=2.235, P=0.031; t=2.086, P=0.044). The difference at 3 months was not statistically significant ( t=0.385, P=0.701). The muscle strength of psoas major of the block group, meanwhile, was higher than those of the control group on the 1day and 1 week after surgery, the difference was statistically significant as well ( t=2.208, P=0.032; t=2.171, P=0.034). The difference at 1 and 3 months was not statistically significant ( t=0.923, P=0.359; t=1.437, P=0.160). No statistically significant differences were found in VAS scores of numbness at 1 day, 1 week, 1 month, and 3 months after surgery. Postoperative low back pain and lumbar spine function were significantly improved in both groups, and there was no statistical significance between the two groups. Coronal Cobb angle and sagittal balance were significantly improved in both groups after surgery, and there was no statistical significance between the two groups. Conclusion:Psoas major intramuscular block therapy can reduce the incidence of early postoperative complications of multi-segmental CLIF. Furthermore, it was found to be effective to alleviate anterior thigh pain within 1 month, and improve psoas major muscle weakness within 1 week.

Objective:To establish an artificial intelligence (AI)-assisted diagnostic system for lung cancer via deep transfer learning.Methods:The researchers collected 519 lung pathologic slides from 2016 to 2019, covering various lung tissues, including normal tissues, adenocarcinoma, squamous cell carcinoma and small cell carcinoma, from the Beijing Chest Hospital, the Capital Medical University. The slides were digitized by scanner, and 316 slides were used as training set and 203 as the internal test set. The researchers labeled all the training slides by pathologists and establish a semantic segmentation model based on DeepLab v3 with ResNet-50 to detect lung cancers at the pixel level. To perform transfer learning, the researchers utilized the gastric cancer detection model to initialize the deep neural network parameters. The lung cancer detection convolutional neural network was further trained by fine-tuning of the labeled data. The deep learning model was tested by 203 slides in the internal test set and 1 081 slides obtained from TCIA database, named as the external test set.Results:The model trained with transfer learning showed substantial accuracy advantage against the one trained from scratch for the internal test set [area under curve (AUC) 0.988 vs. 0.971, Kappa 0.852 vs. 0.832]. For the external test set, the transferred model achieved an AUC of 0.968 and Kappa of 0.828, indicating superior generalization ability. By studying the predictions made by the model, the researchers obtained deeper understandings of the deep learning model.Conclusions:The lung cancer histopathological diagnostic system achieves higher accuracy and superior generalization ability. With the development of histopathological AI, the transfer learning can effectively train diagnosis models and shorten the learning period, and improve the model performance.

Objective To explore the impact of cage position on indirect decompression and cage subsidence in crenel lateral interbody fusion (CLIF).Methods Retrospectively,18 mens and 16 womens with a mean age of 63.98±5.99 years (range:52-75 years) who underwent CLIF for lumbar stenosis by our surgical group during November 2016 and Feburary 2018 were reviewed.Sixty-two segments were included for radiographic evaluation.Endplates thickness was measured using high resolution computed tomography.By image processing,endplate thickness was measured at 10 equally distributed points on the mid-sagittal and mid-coronal planes,and two further planes were measured at an angle of 45° to both the first and second planes.Contour plots representing an isoline of endplate thickness was drawn based on those data.The cages were classified into anterior group and medium-posterior group.Radiographic evaluation included segmental angle,anterior and posterior disk heights,intervertebral foramen heights,and cross-sectional area of the spinal canal.To assess the factors affecting the postoperative segmental angle and cross-sectional area of the spinal canal,univariate and multivariate analysis were performed using the regression analysis model.Cage subsidence was recorded at the last follow-up.Results The mean follow-up time of those patients were 10.88±3.73 months (range:6-18 months).At each spot,the mean thickness was significantly greater for the cranial endplate of disc than the caudal endplate.Contour plots show more areas of thick bony endplates in the anterior and anterolateral part of the endplate than the lateral and posterior part,especially for the cranial endplate.The cage was placed in the anterior area for 19 levels and medium-posterior for 41 levels.The mean increase of anterior disk height was 3.38±3.38 mm in anterior group and 1.83±3.08 mm in medium-posterior group(P=0.04).The mean increase of segmental angle was 2.93°±3.47°in anterior group and 0.73°±3.60° in medium-posterior group(P=0.04).No significant difference was found with mean increase of posterior disk height,mean increase of intervertebral foramen heights,as well as increase ratios of cross-sectional area of the spinal canal between groups.Multivariate analysis showed that the increase of segmental angle was affected by cage position (β=1.24,P=0.03),but the increase ratios of cross-sectional area of the spinal canal was not affected.The subsidence rate of anterior group was 15.79％ (3/19) and medium-posterior group was 24.39％ (10/41),which was not significantly different (x2=0.56,P=0.45).Conclusion There are more areas with thick bony endplates in the anterior and anterolateral parts of the lumbar endplate than the lateral and posterior parts.The cage position at the anterior 1/3 of disk space is better for achieving the restoration of the segmental angle and having lower subsidence rate,without compromising the indirect neural decompression in crenel lateral interbody fusion.

Objective To present the modified surgical technique of lateral lumbar interbody fusion and investigate its approach related complications.Methods Fifty-eight patients treated with novel surgical technique of lateral lumbar interbody fusion(LLIF)from June 2016 to January 2017 were studied retrospectively.There were 24 males and 34 females,aged from 45 to 82 years old(averaged at 66.1±12.1).The diagnosis was as following:degenerative spinal scoliosis in 24 cases,degenerative lum-bar spinal stenosis in 16,lumbar spinal spondylolisthesis in 14,spinal infection and spinal trauma in 2 respectively.The modified surgical technique included operation under direct visualization,the"safety"transpsoas approach and the adjustable microretrac-tor.The patient was placed in a lateral decubitus position,and a transverse or oblique skin incision was planned using fluoroscopy to target the center of the desired disc spaces.The 3 abdominal layers were split longitudinally along the muscle fiber.The psoas major was split longitudinally along the muscle fiber according to the"safety"working window.The adjustable microretractor was used as working corridor to carry out interbody fusion. Oswestry disability index (ODI) was used to assess the clinical outcome. The surgical time,estimated blood loss and approach related complications(pain/numbness at anterior thigh,weakness of psoas muscle and quadriceps)were recorded.Results All patients were followed up from 6-12months,the mean follow-up time(9.1± 2.3)months.A total of 132 levels were performed with novel surgical technique of LLIF,one level in 19 cases,2 levels in 10,3 lev-els in 23 and 4 levels in 6 cases.The mean surgical time was(57.2±13.3)min for 1 level,(94.5±31.3)min for 2 levels,(129.8± 42.1)min for 3 levels and(208.3±22.7)min for 4 levels.The estimated blood loss during surgery was less than 10ml every level. Preoperative ODI was 61.8%±20.1%,it was 22.5%±18.3%(t=7.572,P=0.000)at the last time follow-up.The incidence rate of ap-proach related complications was 12.1%(7/58),with anterior thigh pain in 6 cases(10.3%),numbness 5 cases(8.6%)and psoas major weakness 3 cases(5.2%).No quadriceps weakness,vascular injury,sympathetic nerve injury,visceral injury and ureteral in-jury was found in these series.The incidence rate of complications increased significantly in patients underwent three or more lev-els interbody fusion(χ2=4.453,P=0.035).Conclusion The modified surgical technique reduces the approach related complica-tions of traditional lateral lumbar interbody fusion through the operation under the direct visualization, the"safety"transpsoas approach and the adjustable microretractor.

Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive opendoor laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament.Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old,ranging from 39 to 71 years.Among these patients,21 patients underwent C2 domelike expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty,the patients in both groups underwent the C3-C7 expansive open-door laminoplasty.The preoperative and postoperative Neck Disability Index (NDI),Japanese Orthopedic Association (JOA) score,the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed.Results All patients were followed up,the follow-up time was from 15 to 63 months (mean 42.3±17.7 months).There was no significant difference in the general condition,NDI,JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups.There were significant differences in the NDI,JOA,VAS and SAC between preoperative and postoperative follow-up in 2 groups.The VAS score in C2 dome-like expansive laminoplasty group 1.52± 1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23,P＜0.05),while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 1 L86± 1.014(t=-6.89,P＜0.05).No failure of internal fixation or recurrent compression was found during follow-up.Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level,both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty can achieve good results.The SAC in C2 expansive open-door laminoplastygroup was superior to that in C2 dome-like expansive laminoplasty group,while the postoperative pain was more obvious.There was no significant difference in postoperative neurological recovery between the two groups.Using C2 dome-like expansive laminoplasty could reduce postoperative axial pain than the C2 expansive open-door laminoplasty surgery.For patients withossified tissue in the spinal canal,which occupies more than 50％ of the sagittal diameter of the spinal canal,or with developmental spinal stenosis,C2 expansive open-door laminoplasty may berecommend to get more adequate decompression.

Objective To determine the outcome of unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation.Methods A retrospective case series study was made on 17 patients with unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation and fusion from January 2008 to December 2015.There were 13 males and 4 females,with age range of 34-69 years (mean,47.8 years).All atlas fractures were Jefferson fractures (Levine-Edwards type Ⅲ).Classification of transverse ligament rupture was type Ⅰ in 12 patients and type Ⅱ in 5 patients.No patients had neurologic deficit [American spinal injury association (ASIA) classification grade E].Operation time,blood loss,implant failure,bone fusion and visual analogue scale (VAS) were recorded after operation.Results Operation time was 85-120 min (mean,102 min).Blood loss was 90-150 ml (mean,115 ml).All patients were followed up for 10-20 months (mean,17.8 months).At the final follow-up,all patients achieved bone union,with no implant loosening or breakage happened.VAS was improved from preoperative (5.5 ± 1.8) points to (2.4 ± 1.5) points at tbe final follow-up (P ＜ 0.05).ASIA Grade E remained in all patients.Conclusion Posterior atlantoaxial transpedicular screw fixation of unstable atlas fractures combined with rupture of transverse ligament is a safe and effective surgical procedure that is able to restore the atlanto-axial vertebral stability and relieve pain.