Objective:To explore the effect and safety of endoscopic tubular musculoskeletal tumor surgery (ETMS) technology in spinal tumors.Methods:Clinical data were retrospectively collected from 18 spinal tumor patients who were treated with ETMS technology at Tianjin Medical University Cancer Institute and Hospital ( n=16) or the Affiliated Hospital of Qingdao University ( n=2) from November 2022 to December 2023. The total cohort included 11 males and 7 females, with the age at 60.3±8.6 years (range of 41-76). Two cases were diagnosed with benign tumors, four patients were diagnosed with spinal hematologic malignancies while other 12 cases were patients with spinal metastases. After localization under the C-arm X-ray machine, the spinal endoscopic channel is established using dilators. Soft tissue is dissected under endoscopic guidance to create an artificial cavity. Subsequently, the saline medium relied upon by the spinal endoscopic technique is removed, and posterior decompression and tumor curettage are performed using tubular techniques. Frankel grade classification and paraplegia index were used to evaluate the improvement of postoperative function and the VAS score was performed in pain scoring. The surgical complications and tumor evaluation were observed by postoperative outpatient and telephone follow-up. Results:The ETMS technology was successfully completed in all 18 patients with the mean operation time of 240.3±80.2 min. The median of intraoperative bleeding was 200.0(172.5, 350.0) ml and the mean postoperative drainage was 131.4±69.5 ml. The median value of postoperative hospitalization days was 6.0(4.0, 10.25) d. The paraplegia index decreased from 1.5(0, 3.0) preoperatively to 0(0, 1.25) postoperatively ( Z=-2.599, P=0.009). All the patients presented an improvement in Frankel grading after surgery except for one patient (downgrading from grade E to grade D). There was significantly difference in Frankel grading between preoperative and postoperative groups ( Z=2.812, P=0.005). The median value of preoperative VAS score was up to 5.5(4.0, 7.0) while the median value at postoperative, one month after surgery and three months after surgery were 1.5(1.0, 2.25), 1.0(0, 1.0) and 0(0, 1.0), respectively (χ 2=44.641, P<0.001). The 3-month postoperative VAS improvement rate was 91.2% (range 75%-100%). During a mean follow-up period of 7.6±6.2 months, none of the 18 patients presented surgical complications or tumor recurrence at surgical region. Only one patient died at 3.2 months after surgery until the last follow-up due to respiratory failure after lung tumor progression. The mean survival of the total cohort was up to 13.3 [95% CI (11.5, 15.0)] months. The 16 cases with spinal metastases or spinal hematological malignancies had a mean survival of 13.2 [95% CI (11.3, 15.0)] months. Conclusion:The ETMS technology presented good efficacy and safety in treatment of spinal tumors with low blood supply and with diameter less than 5cm.

Objective:To investigate the effect of immediate breast reconstruction with a deep inferior epigastric artery perforator flap (DIEPF) after the modified radical mastectomy with nipple and areola preservation for breast cancer.Methods:Clinical data from November 2021 to March 2023 of 14 patients with ages from 29 to 49 (mean 40) years old were retrospectively analysed. All the patients received nipple-areola complex-preserving modified radical mastectomy for breast cancer followed by breast reconstruction with DIEPF at the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University. Three patients had left breast cancer and 11 had right breast cancer. Preoperative CTA was used to clarify the course and branching of the deep inferior epigastric artery (DIEA) and identify dominant perforators. Intraoperatively, indocyanine green (ICG) angiography was conducted to assess the perfusion of the flap and patency of the vascular anastomoses. Reconstructive surgery were performed using unilateral DIEPF in 4 patients and bilateral DIEPF with internal pressurization in 10 patients. Seven patients underwent anastomosis with intrathoracic vessels as recipient vessels, and 7 with thoracodorsal vessels. The weight of the resected breast tissue was 325.8 g±17.1 g, and the weight of the reconstructed breast flap was 332.9 g±32.1 g. The size of the harvested DIEPF ranged from 16.0 cm×9.0 cm to 24.0 cm×12.0 cm, with the length of the vascular pedicle anastomosed to the recipient vessels at 11.4 cm±1.5 cm. The donor sites were closed by layers with tension-reducing sutures, and the position of the umbilicus was relocated and sutured. All patients were included in the scheduled postoperative follow-up at the outpatient clinic after discharge.Results:Of all 14 patients, no postoperative crisis compromise of flap occurred, and both the recipient and donor sites healed primarily. During a follow-up period of 6 to 16 months, with an average of 11 months, no breast cancer recurrence was observed, and the aesthetic outcomes of the reconstructed breast were satisfactory without obvious complications.Conclusion:Breast reconstruction with DIEPF immediately after modified radical mastectomy with sparing nipple and areola can achieve good aesthetic results, less complications in the donor site and with high patient satisfaction rate.

Objective:To explore the risk factors of hypotension in patients with hemodialysis-related superior vena cava diseases.Methods:This was a retrospective cohort study. The maintenance hemodialysis patients diagnosed as superior vena cava stenosis ≥50% or occlusion in West China Hospital of Sichuan University from January 1, 2019 to March 31, 2022 were selected. The patients were divided into hypotensive group and non-hypotensive group according to the occurrence of hypotension during non-dialysis period. The differences of general clinical data, cardiac ultrasound parameters and blood biochemical indexes between the two groups were compared. Multivariate logistic regression model was used to analyze the risk factors of hypotension in patients with hemodialysis-related superior vena cava lesions.Results:A total of 202 patients with hemodialysis-related superior vena cava lesions were included, of whom 84 patients (41.6%) developed hypotension during non-dialysis. Compared with the non-hypotensive group, patients in the hypotensive group had longer dialysis age ( Z=2.093, P=0.036), shorter left atrial diameter ( t=2.316, P=0.022), lower aortic valve orifice flow rate ( t=3.702, P=0.001) and serum calcium ( t=2.320, P=0.021), thicker left ventricular posterior wall ( t=3.042, P=0.003), lower proportions of hypertension history ( χ2=9.125, P=0.003), and higher proportion of residual superior vena cava ≤30% or occlusion ( χ2=8.940, P=0.003) and azygous vein opening ( χ2=11.067, P=0.001). Multivariate logistic regression analysis results showed that no history of hypertension ( OR=0.383, 95% CI 0.156-0.943, P=0.037), slow aortic valve orifice flow ( OR=0.207, 95% CI 0.062-0.695, P=0.011) and low blood calcium ( OR=0.236, 95% CI 0.066-0.841, P=0.026) were the independent influencing factors of hypotension in patients with hemodialysis-related superior vena cava diseases. Conclusions:Hemodialysis patients with severe stenosis or occlusion of the superior vena cava during non-dialysis have a higher risk of hypotension. No history of hypertension, slow aortic valve orifice flow, and low blood calcium are the independent risk factors of hypotension in patients with hemodialysis-related superior vena cava diseases.

Heart sound is one of the common medical signals for diagnosing cardiovascular diseases. This paper studies the binary classification between normal or abnormal heart sounds, and proposes a heart sound classification algorithm based on the joint decision of extreme gradient boosting (XGBoost) and deep neural network, achieving a further improvement in feature extraction and model accuracy. First, the preprocessed heart sound recordings are segmented into four status, and five categories of features are extracted from the signals based on segmentation. The first four categories of features are sieved through recursive feature elimination, which is used as the input of the XGBoost classifier. The last category is the Mel-frequency cepstral coefficient (MFCC), which is used as the input of long short-term memory network (LSTM). Considering the imbalance of the data set, these two classifiers are both improved with weights. Finally, the heterogeneous integrated decision method is adopted to obtain the prediction. The algorithm was applied to the open heart sound database of the PhysioNet Computing in Cardiology(CINC) Challenge in 2016 on the PhysioNet website, to test the sensitivity, specificity, modified accuracy and F score. The results were 93%, 89.4%, 91.2% and 91.3% respectively. Compared with the results of machine learning, convolutional neural networks (CNN) and other methods used by other researchers, the accuracy and sensibility have been obviously improved, which proves that the method in this paper could effectively improve the accuracy of heart sound signal classification, and has great potential in the clinical auxiliary diagnosis application of some cardiovascular diseases.
Algorithms ; Databases, Factual ; Heart Sounds ; Neural Networks, Computer

Objective To research the effect of pure interbody fusion and interbody cage fusion under minimally invasive transforaminal lumbar interbody fusion treat to single segment of lumbar disc herniation,analysis clinical value the two methods.Methods A total of 61 cases single segment lumbar disc herniation were treated with MIS-TLIF surgery,were divided into pure interbody fusion group (group A) and interbody fusion Cage group (group B) according to different fusion methods.Operative time,blood loss and postoperative drainage were recorded in two groups,the clinical efficacy were tested by using of visual analogue score (VAS),Japanese Orthopedic Association scores (JOA),Oswestry disability index (ODI) score and Macnab standard,the interbody fusion ability were evaluated by power lumbar X-ray film and CT 3D reconstruction.Results The gender,age,disease duration and disease segments in two gracps were not found statistically significant difference (P＞0.05).Also,two groups of patients,blood loss,postoperative drainage has no significant difference (P＞0.05).After the operation,the VAS score,ODI score,JOA score and Macnab criteria,the last follow-up of intervertebral fusion rate in in tuo groups were not found statistically significant difference (P＞0.05).While the operative time,postoperative disc height changes were found significant difference between two groups (P＜ 0.05).Conclusion MIS-TLIF simple fusion for lumbar disc herniation will be available with equal clinical efficacy fusion rate compared with cage fusion.

Objective To study and observe the influence of comprehensive rehabilitation intervention on the vertebral parameters and pain substance of patients with lumbar vertebra fracture.Methods A total of 78 patients with lumbar vertebra fracture treated with rehabilitation intervention were selected,and they were randomly divided into control group (routine rehabilitation intervention group) and observation group (comprehensive rehabilitation intervention group),39 cases in each group.The VAS score,Oswestry disability index and vertebral parameters,serum pain related indexes before the intervention and after the intervention were analyzed and compared.Results The VAS score and Oswestry disability index of observation group at different time after the intervention were significantly better than those of control group,the vertebral parameters were significantly better than control group,and serum pain related indexes were significantly lower than control group (P ＜ 0.05).Conclusion Comprehensive rehabilitation intervention can improve the vertebral parameters and pain substance of patients with lumbar vertebra fracture.

Objective To study and observe the influence of comprehensive rehabilitation intervention on the vertebral parameters and pain substance of patients with lumbar vertebra fracture.Methods A total of 78 patients with lumbar vertebra fracture treated with rehabilitation intervention were selected,and they were randomly divided into control group (routine rehabilitation intervention group) and observation group (comprehensive rehabilitation intervention group),39 cases in each group.The VAS score,Oswestry disability index and vertebral parameters,serum pain related indexes before the intervention and after the intervention were analyzed and compared.Results The VAS score and Oswestry disability index of observation group at different time after the intervention were significantly better than those of control group,the vertebral parameters were significantly better than control group,and serum pain related indexes were significantly lower than control group (P ＜ 0.05).Conclusion Comprehensive rehabilitation intervention can improve the vertebral parameters and pain substance of patients with lumbar vertebra fracture.

Objective To investigate the efficacy and toxicity of stereotactic ablative radiotherapy for stage Ⅰ peripheral non-small cell lung cancers.Methods Thirty six patients of stage Ⅰ peripheral non-small cell lung cancers were treated with stereotactic ablative radiotherapy.The prescription dose was 12 Gy per fraction ×4 fraction in one to two weeks.The 100％ planning target volume (PTV) was covered by the isodose curve of 95％ prescription dose.Organs at risk and their respective tolerance doses used during treatment planning were developed from the research scheme of the Radiation Therapy Oncology Group 0236.Before the radiation delivery,all patients were scanned by the fan beam CT or the cone beam CT for image guidance and registration.The follow-up for the patients was given to observe the toxicity and efficacy of stereotactic ablative radiotherapy (SABR).Results The median follow-up time was 18.7 months (range of 4 to 36 months).After treatment,the overall response rate was 88.9％,with complete response (CR) 17 cases(47.2％),partial response (PR) 15 cases(41.7％),and stable disease (SD) 4 cases(11.1％).The estimated overall survival rate at 1 and 3 years was 92.3％ (95％ confidence interval [CI],86.3％ ～97.1％) and 85.3％ (95％ CI,80.5％ ～90.6％).The estimated local control rate at 3 years was 90.2％ (95％ CI,85.7％ ～94.8％).There was no gradeⅢ or above toxicity related to treatment.Conclusions The stereotactic ablative radiotherapy attains good local control and survival efficacy for the stage Ⅰ peripheral non-small lung cancer patients.It is well tolerated owing to low toxicity.

Objective To explore the inhibition of Zn(PMFPCl) 2 on HepG2 cells and its mechanism.Methods The HepG2 cells were divided into control group and experimental group of 10, 30 and 70 μmol/L.The cell proliferation was detected by MTT assay, cell apoptosis and cell cycle was analysed by flow cytometry, cellular morphological change was observed with inverted microscope and the expressions of apoptosis-regulated proteins of p53, p21, caspase-3, bax and bcl-2 in HepG2 cells were detected by Western blot.Results The inhibitory rates of experimental groups (10, 30, 70μmol/L) at 24, 48 and 72h were significantly higher than those of control group (P<0.05), and the highest one was 63.29% of 70 μmol/L Zn (PMFPCl)2at 72 h.The apoptosis rates of each experimental group at 48h was significantly higher than that of control group (P<0.05).The cells were induced a remarkable G1 arrest by Zn(PMFPCl) 2 which could inhibit proliferation.The number of adherent cells reduced and cells shrank, convex on cytomembrane surface appeared and the cells changed to round and were brighter.Western blot results showed that the protein levels of p53, p21, caspase-3 and bax increased and bcl-2 decreased with the Zn(PMFPCl)2concentration increasing (P<0.05).Conclusion Zn(PMFPCl)2 could inhibit the proliferation and promote apoptosis of HepG2 cells whose mechanisms are promotation of p53, p21, caspase-3 and bax expressions and inhibition of bcl-2 expression.