Objective To propose a multi-cascade deep learning processor-based surgical instrument detection and pose estimation algorithm to facilitate the robotic scurb nurse to recognize and delivery surgical instruments.Methods The proposed multi-cascade deep leaning processor-based CYSP algorithm was hibernated with several functional modules such as YOLOX with coordinate attention block(CA-YOLOX),segment anything model(SAM)and principal component analysis(PCA).Firstly,CA-YOLOX was applied to identifying the types of the surgical instruments and completing the coarse positioning of x and y coordinates;secondly,the SAM segmenter was used to clarify the positions of the instruments in the RGB image,and the depth information and internal parameters of the camera were introduced to obtain the point cloud of the surgical instruments;finally,the center of mass,principal direction and normal direction of the surgical instrument point cloud were determined through the PCA algorithm,with which the rotation and translation(RT)matrix between the target coordinate system(surgical instrument center of mass coordinate system)and the base coordinate system of the robotic arm was solved,and the matrix was converted into a quaternion and then transmitted to the robotic arm control unit so as to drive the robotic arm to arrive at the corresponding position and pick up the instrument to complete the instrument delivery task.Migration training was accomplished on a self-constructed surgical instrument image dataset and the effectiveness of the proposed algorithm was evaluated,and instrument delivery experiments were performed on a seven-degree-of-freedom robotic arm and the success rate of the algorithm was assessed.Results The multi-cascade deep leaning processor-based CYSP algorithm had a recognition accuracy of 98.52％on the surgical instrument dataset,a success rate of 94％for the in-strument delivery experiment and average time for recognition of 0.28 s.Conclusion The multi-cascade deep leaning proces-sor-based CYSP algorithm with high reliability and practicability behaves well in facilitating the robotic scurb nurse to recog-nize and deliver surgical instruments.[Chinese Medical Equipment Journal,2024,45(6):1-8]

Glycogen synthase kinase-3β (GSK-3β) is an important serine/threonine kinase that implicates in multiple cellular processes and links with the neurodegenerative diseases including Alzheimer’s disease (AD). In this study, structure-based virtual screening was performed to search database for compounds targeting GSK-3β from Enamine’s screening collection. Of the top-ranked compounds, 7 primary hits underwent a luminescent kinase assay and a cell assay using human neuroblastoma SH-SY5Y cells expressing Tau repeat domain (TauRD) with pro-aggregant mutation ΔK280. In the kinase assay for these 7 compounds, residual GSK-3β activities ranged from 36.1% to 90.0% were detected at the IC50 of SB-216763. In the cell assay, only compounds VB-030 and VB-037 reduced Tau aggregation in SH-SY5Y cells expressing ΔK280 TauRD-DsRed folding reporter. In SH-SY5Y cells expressing ΔK280 TauRD, neither VB-030 nor VB-037 increased expression of GSK-3α Ser21 or GSK-3β Ser9. Among extracellular signal-regulated kinase (ERK), AKT serine/threonine kinase 1 (AKT), mitogen-activated protein kinase 14 (P38) and mitogenactivated protein kinase 8 (JNK) which modulate Tau phosphorylation, VB-037 attenuated active phosphorylation of P38 Thr180/ Tyr182, whereas VB-030 had no effect on the phosphorylation status of ERK, AKT, P38 or JNK. However, both VB-030 and VB-037 reduced endogenous Tau phosphorylation at Ser202, Thr231, Ser396 and Ser404 in neuronally differentiated SH-SY5Y expressing ΔK280 TauRD. In addition, VB-030 and VB-037 further improved neuronal survival and/or neurite length and branch in mouse hippocampal primary culture under Tau cytotoxicity. Overall, through inhibiting GSK-3β kinase activity and/or p-P38 (Thr180/Tyr182), both compounds may serve as promising candidates to reduce Tau aggregation/cytotoxicity for AD treatment.

OBJECTIVE: To establish a prognostic nomogram based on response to bortezomib and BTK expression for treatment-experienced multiple myeloma patients. METHODS: The Oncomine database was utilized to determine BTK expression, sex, age, albumin, Mayo index, response to bortezomib treatment, follow-up time and survival status in multiple myeloma(MM) patients. Cut-off point for BTK expression was calculated using R software. Univariate and multivariate analyses by Cox proportional hazards regression were then performed. Significant prognostic factors were combined to build a nomogram. The discrimination ability and predictive accuracy of the nomogram were evaluated using the index of concordance (C-index) and calibration curves. RESULTS: Multivariate analysis showed that response to bortezomib, BTK expression and sex were independent risk factors for prognosis. The C-index value of the nomogram made according to the independent risk factors was 0.729 (95%CI, 0.642-0.8164). The calibration curves showed good consistency between predicted and actual survivals for 1-year and 2-year overall survival. CONCLUSION The proposed nomogram is accurate in predicting the prognosis of patients with MM.
Bortezomib/therapeutic use* ; Humans ; Multiple Myeloma/drug therapy* ; Nomograms ; Prognosis ; Proportional Hazards Models

Objective The aim is to analyze the spatial epidemiological characteristics for human infection with avian influenza H7N9 in Fujian Province, so as to provide scientific evidence for developing and adjusting related control strategies. Methods The epidemiological data of human infection with H7N9 avian influenza in Fujian Province, from 2013 to 2017 was analyzed by SAS 9.2, ArcGIS 10.3 and SaTScan 9.4 software.Results There were a total of 108 cases and 28 deaths reported in Fujian Province, up to December 31, 2017. The case fatality rate was 25.93%.96.30% of cases were sporadic. There were more incidences in winters and springs, more incidences in rural areas. The global spatial autocorrelation and high/low clustering analysis indicated that clusters at the county level were in the shore areas (Z=3.74, P<0.001; Z=5.26, P<0.001). The cities of Changle, Fuqing, Jinjiang and Siming were the high-high clustered areas and local hot-points. There were two clusters, from December 2014 to March 2015, the most likely cluster regions was centered around Zhangpu County with a radius of 63.04 km (RR=4.72, LLR=11.41, P<0.001). The secondary cluster regions was centered around Fuqing City with a radius of 81.98 km (RR=4.07, LLR=7.96, P=0.037). Conclusions Human infection with avian influenza H7N9 in Fujian Province is spatially and temporally clustered. The measures of prevention and control should be focused on high incidence seasons and key regions, and the surveillance of etiology should be strengthened.

Objective To invesgate the safety and efficacy of the second generation biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL2) stent in diabetic patients by a subgroup analysis of of the CREDITⅡand CREDIT Ⅲ trials. Methods All patients who were implanted with the EXCEL2 stent were enrolled in the CREDITⅡand CREDIT Ⅲ trials. The primary endpoint was target lesion failure at 24-month, defi ned as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization(TLR). The secondary endpoint was endpoints including all-cause death, all myocardial infarction (MI) or any revascularization.Results A total of 828 patients were included from the patients who were implanted with the EXCEL2 stent in the CREDIT II and CREDIT Ⅲ trials. 24-month follow-up rate was 99.5%. There was no significant difference in the primary endpoint (P>0.05) and event rates of the secondary endpoints(P>0.05) between the diabetic and non-diabetic group, which included all-cause death[diabetics (2.5%)vs.non-diabetics(1.4%),P>0.05],myocardial infarction(MI)(7.5% vs.5.0%,P>0.05),all from of revascularization(5.0% vs.3.9%,P>0.05),and stent thrombosis(0.6% vs.0.4%,P>0.05).Conclusions EXCEL 2 stent met the objective performance goal on effcacy and safety, which can reduce make stent restenosis, target vessel revascularization ,with 160 diabetic cases among them, and stent thrombosis in diabetic patients.

Growth hormone (GH), as a vital hormone, has to experience a series of processes to fulfill its function including secretion, entering the circulation to reach target tissues (pre-receptor process), binding on the GH receptor (GHR) and triggering signaling inside cells (post-GHR process). Insulin can directly or indirectly influence part of these processes. GH secretion from pituitary somatotropes is regulated by GH-releasing hormone (GHRH) and somatostatin (SS) from hypothalamus. Insulin may exert positive or negative effects on the neurons expressing GHRH and SS and somatotropes under healthy and pathological conditions including obesity and diabetes. Glucose and lipid levels in circulation and dietary habits may influence the effect of insulin on GH secretion. Insulin may also affect GHR sensitivity and the level of insulin-like growth factor 1 (IGF-1), thus influence the level of GH. The GH signaling is also important for GH to play its role. GH signaling involves GHR/JAK2/STATs, GHR/JAK2/SHC/MAPK and GH/insulin receptor substrate (IRS)/PI3K/Akt pathways. These pathways may be shared by insulin, which is the basis for the interaction between insulin and GH, and insulin may attenuate or facilitate the GH signal by influencing molecules in the pathways. Many factors are related to the effect of insulin, among them the most important ones are duration of action and amount of insulin. The tendency of insulin-reduced GH signaling becomes obvious with increased dose and acting time of insulin. The participation of suppressor of cytokine signaling (SOCS), the interaction between JAK2 and IRS, and GHR sensitivity should also be considered when discovering GH signal. The involvement of SS in response to insulin is not clear yet. The details of how GH secretion, level and signaling change in response to time and dose of insulin treatment warrant further studies.

Objective To investigate the effect of different doses of pralidoxime chloride on clinical outcome including recovery rate and mortality in patients with acute organophosphorus pesticide poisoning.Methods According to the total amount of pralidoxime chloride administered over the first 24 hours or entire duration of hospitalization,a cohort of 163 organophosphorus pesticide poisoning patients,admitted from February 2004 to December 2014 were assigned to different groups followed by a retrospective analysis.Comparisons of recovery rate,mortality rate,mean length of hospital stay,and duration of mechanical ventilation were made among groups.SPSS 18.0 was used to analyze categorical variables between the data of groups with x2 test/Fisher exact probability method and numerical variables with t test or One-way ANOVA,and statistical significance was set as P ＜ 0.05.Results According to the amount of pralidoxime chloride given over the first 24 hours,the recovery rate and the mortality rate were significantly improved in the experimental group (pralidoxime chloride ＞ 2 g) than in the control group (pralidoxime chloride ＜ 2 g) (P =0.04).There was no significant difference in mean length of hospital stay between the experimental group and the control group (P =0.171),and there were statistically significant differences in recovery rate and mortality rate among the four dose-response subgroups (total dosage administered in 24 hours in group A ＜ 1 g,in group B ＜2 g,in group C ＜4 g and in group D ＞4 g) (P =0.034).Based on the total amount of pralidoxime chloride prescribed in the entire duration of hospital stay,the recovery rate and mortality rate were significantly better in the experimental group than those in control group (P =0.002),and among the three dose-response subgroups,the significant difference in recovery rate and mortality rate were also observed (P =0.006).Conclusions Increased amounts of pralidoxime chloride prescribed in the first 24 hours and in the whole hospitalized period can improve the recovery rate and reduce the mortality rate in organophosphorus pesticide poisoning patients.

Objective: To evaluate the method and curative effect of plate fixation or percutaneous screws for the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ via a minimally invasive sinus tarsi incision combined with a variety of manipulative reduction methods. Methods: Twenty-one patients with closed calcaneal fractures treated in the Department of Orthopedics, the First Affiliated Hospital of Nanchang University from January 2014 to January 2016 were collected. There were 15 men and 6 women, with an average age of 39.3 years(from 25 to 63 years). According to the Sanders classification, 16 cases were type Ⅱ and 5 were type Ⅲ.All cases were treated with internal fixation with plate and percutaneous screws via the mini-open sinus tarsi approach following reduction of the posterior articular surface of the subtalar joint and calcaneal length, width and height.Statistical analysis was performed on calcaneal width and Böhler angle, Gissane angle preoperatively and postoperatively (3 days and 3 months). All data were analyzed by ANOVA, functional recovery was evaluated according to the Ankle and Hind-foot Score of American Orthopedic Foot and Ankle Society (AOFAS). Results: Twenty one patients were followed up for a mean duration of 13.4 months(6 to 24 months). All cases gained primary incision healing, without complications such as skin necrosis, wound infection, tenosynovitis of peroneus longus and brevis muscles, or fracture displacement and hardware failure.Bone union was achieved at an average of 10.5 weeks(9 to 11 weeks). No obvious malunion occurred by the last follow-up. Compared to preoperative, calcaneal width(F=25.62, 38.90) were significantly improved 3 days and 3 months after surgery, Böhler angle(F=440.24, 272.42) and Gissane angle(F=91.86, 43.74) were normal, the differences were statistically significant (all P<0.05). Compared to 3 days after surgery, calcaneal width, Böhler angle and Gissane angle kept normal 3 months after surgery, there were no statistically differences (F=0.26, 1.35, 2.60, all P>0.05). By the AOFAS scoring, 10 cases were rated as excellent, 7 were good and 4 were fair. Conclusions Fixation with plate and percutaneous screws via the mini-open sinus tarsi approach is an effective treatment for Sanders types Ⅱ and Ⅲ calcaneal fractures, which with the advantages of small wound, simple operation, reliable fixation, no incision complication, especially suitable for elderly patients and the patients with severe injury of local soft tissue.

OBJECTIVETo investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.

METHODSThe registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).

RESULTSThe preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).

CONCLUSIONPROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.

Apgar Score ; Birth Weight ; Female ; Fetal Membranes, Premature Rupture ; pathology ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Newborn, Diseases ; etiology ; Infant, Premature ; Pregnancy ; Risk Factors

BACKGROUNDStaphylococcus aureus is one of the predominant causes of skin and soft tissue infections (SSTIs), but limited data were available regarding the characterization of S. aureus from SSTIs patients in Jiangsu Province in China. We aimed to investigate the molecular epidemiology of S. aureus among SSTIs patients in two hospitals of Jiangsu Province.

METHODSSixty-two patients with SSTIs from two Chinese hospitals in Jiangsu Province were enrolled in this study, and 62 S. aureus isolates were collected from February 2014 to January 2015. S. aureus isolates were characterized by antimicrobial susceptibility testing, toxin gene detection, and molecular typing with sequence type, Staphylococcus protein A gene type, accessory gene regulator (agr) group, and Staphylococcal cassette chromosome mec t ype.

RESULTSSixteen (25.8%) methicillin-resistant S. aureus (MRSA) isolates were detected, and there was no isolate found resistant to vancomycin, teicoplanin, sulfamethoxazole-trimethoprim, and linezolid. The sei was the toxin gene most frequently found, and no lukS/F-PV-positive isolates were detected among the SSTIs' patients. Molecular analysis revealed that ST398 (10/62, 16.1%; 2 MRSA and 8 methicillin-susceptible S. aureus) to be the dominant clone, followed by ST5 (8/62, 12.9%) and ST7 (8/62, 12.9%).

CONCLUSIONSThe livestock ST398 was the most common clone among patients with S. aureus SSTIs in Jiangsu Province, China. Surveillance and further studies on the important livestock ST398 clone in human infections are necessarily requested.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacology ; Child ; Child, Preschool ; China ; Female ; Hospitals ; Humans ; Infant ; Linezolid ; pharmacology ; Male ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; isolation & purification ; Microbial Sensitivity Tests ; Middle Aged ; Molecular Epidemiology ; Soft Tissue Infections ; microbiology ; Staphylococcal Infections ; microbiology ; Staphylococcal Skin Infections ; microbiology ; Staphylococcus aureus ; drug effects ; isolation & purification ; Teicoplanin ; pharmacology ; Trimethoprim, Sulfamethoxazole Drug Combination ; pharmacology ; Vancomycin ; pharmacology ; Young Adult