Objective To develop a method for accurate identification of multiscale carotid plaques in ultrasound images.Methods We proposed a two-stage carotid plaque detection method based on deep convolutional neural network(SM-YOLO).A series of algorithms such as median filtering,histogram equalization,and Gamma transformation were used to preprocess the dataset to improve image quality.In the first stage of the model construction,a candidate plaque set was built based on the YOLOX_l target detection network,using multiscale image training and multiscale image prediction strategies to accommodate carotid artery plaques of different shapes and sizes.In the second stage,the Histogram of Oriented Gradient(HOG)features and Local Binary Pattern(LBP)features were extracted and fused,and a Support Vector Machine(SVM)classifier was used to screen the candidate plaque set to obtain the final detection results.This model was compared quantitatively and visually with several target detection models(YOLOX_l,SSD,EfficientDet,YOLOV5_l,Faster R-CNN).Results SM-YOLO achieved a recall of 89.44%,an accuracy of 90.96%,a F1-Score of 90.19%,and an AP of 92.70%on the test set,outperforming other models in all performance indicators and visual effects.The constructed model had a much shorter detection time than the Faster R-CNN model(only one third of that of the latter),thus meeting the requirements of real-time detection.Conclusion The proposed carotid artery plaque detection method has good performance for accurate identification of carotid plaques in ultrasound images.

Objective To develop a method for accurate identification of multiscale carotid plaques in ultrasound images.Methods We proposed a two-stage carotid plaque detection method based on deep convolutional neural network(SM-YOLO).A series of algorithms such as median filtering,histogram equalization,and Gamma transformation were used to preprocess the dataset to improve image quality.In the first stage of the model construction,a candidate plaque set was built based on the YOLOX_l target detection network,using multiscale image training and multiscale image prediction strategies to accommodate carotid artery plaques of different shapes and sizes.In the second stage,the Histogram of Oriented Gradient(HOG)features and Local Binary Pattern(LBP)features were extracted and fused,and a Support Vector Machine(SVM)classifier was used to screen the candidate plaque set to obtain the final detection results.This model was compared quantitatively and visually with several target detection models(YOLOX_l,SSD,EfficientDet,YOLOV5_l,Faster R-CNN).Results SM-YOLO achieved a recall of 89.44%,an accuracy of 90.96%,a F1-Score of 90.19%,and an AP of 92.70%on the test set,outperforming other models in all performance indicators and visual effects.The constructed model had a much shorter detection time than the Faster R-CNN model(only one third of that of the latter),thus meeting the requirements of real-time detection.Conclusion The proposed carotid artery plaque detection method has good performance for accurate identification of carotid plaques in ultrasound images.

Objective To explore the characteristics of sleep structure in chronic insomnia disorder(CID)with disharmony between heart and kidney pattern and liver qi stagnation pattern.Methods A total of 74 patients with CID who were treated in Tongde Hospital of Zhejiang Province from June 2021 to December 2022 were selected and divided into disharmony between heart and kidney group and liver qi stagnation group according to TCM syndrome differentiation types,with 37 cases in each group.Relevant parameters of both groups were collected and analyzed using polysomnography(PSG).Results The age of patients in disharmony between heart and kidney group was significantly higher than that in liver qi stagnation group(P<0.05).There were statistically significant differences in total sleep time,sleep efficiency,rapid eye movement sleep period,N1 stage and N3 stage between two groups(P<0.05).The results indicated that patients in disharmony between heart and kidney group had light sleep,low sleep efficiency and short total sleep time.Conclusion With the increase of age,most of the syndromes of CID patients are disharmony between heart and kidney pattern,and there are obvious differences between the two types of sleep structure.Patients with disharmony between heart and kidney pattern have light sleep and low efficiency,while patients with liver qi stagnation pattern have many dreams.

Type 2 diabetes mellitus (T2DM) therapy is facing the challenges of long-term medication and gradual destruction of pancreatic islet β-cells. Therefore, it is timely to develop oral prolonged action formulations to improve compliance, while restoring β-cells survival and function. Herein, we designed a simple nanoparticle with enhanced oral absorption and pancreas accumulation property, which combined apical sodium-dependent bile acid transporter-mediated intestinal uptake and lymphatic transportation. In this system, taurocholic acid (TCA) modified poly(lactic-co-glycolic acid) (PLGA) was employed to achieve pancreas location, hydroxychloroquine (HCQ) was loaded to execute therapeutic efficacy, and 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) was introduced as stabilizer together with synergist (PLGA-TCA/DLPC/HCQ). In vitro and in vivo results have proven that PLGA-TCA/DLPC/HCQ reversed the pancreatic islets damage and dysfunction, thus impeding hyperglycemia progression and restoring systemic glucose homeostasis via only once administration every day. In terms of mechanism PLGA-TCA/DLPC/HCQ ameliorated oxidative stress, remodeled the inflammatory pancreas microenvironment, and activated PI3K/AKT signaling pathway without obvious toxicity. This strategy not only provides an oral delivery platform for increasing absorption and pancreas targetability but also opens a new avenue for thorough T2DM treatment.

A 44-year-old male patient presented with a subcutaneous nodule in the left little finger for 3 years. Skin examination showed a subcutaneous nodule with rubber-like hardness but no tenderness on palpation, measuring 0.4 cm × 0.4 cm in size at the dorsal distal aspect of the left little finger, and the movement of the distal interphalangeal joint was unrestricted. Postoperative histopathological examination revealed that the tumor contained abundant stroma consisting of variable fiberous, chondroid and myxoid materials; tumor cells were oval to short spindle-shaped with inconspicuous nucleoli but no mitosis; cells were arranged haphazardly or in small clusters. Immunohistochemical study showed positive staining for vimentin, CD34 and transcription factors ERG and SOX9, but negative staining for S100, P63, broad-spectrum cytokeratin AE1/AE3, epithelial membrane antigen, smooth muscle actin and desmin in tumor cells, and the Ki67 labeling index was below 1%. Finally, the patient was diagnosed with acral fibrochondromyxoid tumor.

Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.

Objective:To investigate the short-term clinical outcomes of posterior percutaneous pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating Kümmell's disease with intravertebral instability.Methods:A retrospective case series study was made on 18 patients with Kümmell's disease with intravertebral instability treated at Lishui Hospital of Zhejiang University from January 2012 to February 2016. There were 4 males and 14 females, aged 65-86 years [(76.0±5.5)years]. Segment of injury was T 7 in 1 patient, T 10 in 2, T 11 in 3, T 12 in 4, L 1 in 6, and L 2 in 2. All patients underwent posterior percutaneous pedicle screw fixation combined with PVP. The operation time, intraoperative blood loss, amount of cement injected into the vertebra, and length of postoperative hospital stay were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), Cobb angle, and wedge angle of the operative segment were recorded and compared preoperatively, postoperatively, and at the latest follow-up. Meanwhile, the complications were recorded. Results:All patients were followed up for 12-28 months [(17.7±4.4)months]. The operation time was 110-175 minutes [(137.9±21.9)minutes] and the blood loss was 50-165 ml [(110.7±35.6)ml]. The amount of cement injected into the vertebra was 2.5-6.0 ml [(4.7±0.9)ml]. The length of hospital stay was 7-14 days [(9.4±2.3)days]. The VAS was (7.8±1.2) points preoperatively, (3.3±0.7) points at 1 week postoperatively and (2.4±0.7)points at the latest follow-up. The ODI was (67.3±7.3)% preoperatively, (30.5±7.5)% at 1 week postoperatively and (21.8±8.3)% at the latest follow-up. The Cobb angle was (26.2±9.5)° preoperatively, (12.6±7.2)° at 1 week postoperatively and (16.7±6.2)°at the latest follow-up. The wedge angle was (21.1±6.1)° preoperatively, (8.4±4.6)° at 1 week postoperatively, and (13.2±4.1)° at the latest follow-up. The above clinical and radiological parameters were significantly improved after operation ( P<0.05), and showed no significant differences at the latest follow-up when compared to that at 1 week postoperatively ( P>0.05). Five patients showed slight screw loosening, but there was no obvious dislocation of internal fixation. One case developed distal vertebral compression fracture at 6 months postoperatively and cured after a second PVP. Conclusion:For Kümmell's disease with intravertebral instability, posterior percutaneous pedicle screw fixation combined with PVP can effectively restore and maintain the spinal sequence, rapidly relieve the pain and improve clinical function. However, the long-term efficacy needs further study.

Objective:ASCL-1 gene expression is closely related to pulmonary neuroendocrine (NE) tumors, such as small cell carcino-ma, atypical carcinoid, carcinoid, and large cell NE carcinoma. This study aimed to analyze ASCL-1 protein expression in lung adenocar-cinoma (AD) and its correlation with prognosis. Methods:ASCL-1 protein expression in 283 cases of AD was determined through immu-nohistochemical analysis and compared with the expression of traditional NE markers, including chromogranin A, CD56, and synapto-physin. Western blot was performed to detect the ASCL-1 protein expression levels in AD. Single factor Chi-square test and Logistic multiple factor regression analysis were conducted to explore the factors related to ASCL-1 expression. Kaplan-Meier survival analysis was applied to evaluate the prognosis of patients with AD. Results:Immunohistochemical analysis showed that ASCL-1 expression was positive in 48/283 (16.9%) AD and positively correlated with NE markers (0

OBJECTIVETo observe the effect difference between drug-spreading moxibustion and the oral administration of meloxicam for primary dysmenorrheal with cold stagnation and to explore its mechanism.

METHODSA total of 101 patients with primary dysmenorrheal were randomly assigned into a drug-moxibustion group(52 cases) and a western medication group(49 cases). Drug-spreading moxibustion was used on the lumbosacral acupoints area and then around lower abdominal five days before menstruation until the 3rd day of menstruation,once three days,while western medicine meloxicam was prescribed one day before menstruation,7.5 mg at a time,once a day and continuously for three days. The clinical effects after one course,namely three menstrual cycles,were compared between the two groups. Meanwhile,the resistance index(RI) and the pulsatility index (PI) of uterine artery and arcus arteriarum were examined through color Doppler ultrasound before and after treatment.

RESULTSAfter one-course treatment,the effective rate was 92.3%(48/52) in the drug-spreading moxibustion group,which was better than 67.3%(33/49) in the western medication group(<0.05). Also,all the RI and PI in the drug-spreading moxibustion group were obviously decreased than those before treatment(all<0.05),and the ones were superior to those of the western medication group(all<0.05),which showed no apparent decrease after treatment(all>0.05).

CONCLUSIONSDrug-spreading moxibustion can improve the symptoms of primary dysmenorrheal with cold-damp stagnation,and the effect is better than that of meloxicam. The mechanism may be related to improve the blood supply to the uterus.

Objective To investigate the influence of chronic pain on the sleep quality in the patients with Parkinson′s disease (PD) .Methods 232 cases of PD in the neurology department of this hospital from March 2009 to March 2013 were selected and di‐vided into the pain PD group (PPD group ,106 cases) and the non‐pain PD group (NPPD group ,126 cases) according to whether accompanying chronic pain .Contemporaneous 140 individual of healthy physical examination were selected as the control group .The Pittsburgh Sleep Quality Index Scale (PSQI) and the fatigue scale (FS‐14) were used to judge whether sleep disorders existing . Then the differences in the sleep quality and fatigue condition were compared among three groups .The related factors of sleeping disorders were also analyzed .Results The scores of PSQI and FS‐4 had statistically significant differences among 3 groups (P<0 .05) ,in which the differences in the aspects of sleep latency ,subjective sleep quality ,sleep continuity ,habitual sleep efficiency and sleep disorders also were statistically significant (P<0 .05) .The influencing factors of sleeping disorders were the Hoehn‐Yahr stage (r = -0 .79 ,P<0 .05) ,dopamine dose (r = -0 .38 ,P=0 .04) ,presence of pain (r = -0 .57 ,P<0 .05) and severity of de‐pression (r = -0 .63 ,P<0 .05) .Conclusion The PD patients accompanying pain are more susceptible to develop sleep disorders , the sleep quality accompanying pain is worse than that without accompanying pain .Therefore the early intervention should be well conducted in clinic .