Objective:To develop a set of algorithms that could predict the precise size of acetabular cup preoperatively by the deep learning neural network technology.Methods:Retrospective analysis was performed on 30 patients with femoral head necrosis from April 2019 to April 2020, including 15 males and 15 females. At the age of (54.8±10.5) years (range 33-72 years). Thirteen hips on the left and seventeen hips on the right, who underwent primary unilateral THA. Based on the manually segmented hip joint CT database, a deep learning convolutional neural network was trained to realize automatic segmentation. A customized algorithm was created to fit the surface of the acetabulum. By the application of another deep learning convolutional neural network, the identification of anatomical points of the pelvis and correction of the pelvic position were realized. So that the placement of the acetabulum cup could be done. DOC (dice overlap coefficients) as well as the average error parameter were adopted to evaluate the accuracy of the above steps. The novel algorithm and Orthoview software were retrospectively used to template the acetabular cup separately. The results of both groups were compared with the actual size and the coincidence rate was calculated to evaluate the accuracy of the novel algorithm. To verify this algorithm, the conformance rate was calculated respectively.Results:Compared with other classical segmentation networks, the G-NET network can segment the pelvic with femoral head necrosis more accurately (DOC 92.51%± 6.70%). It also has better robustness. The average error of the point recognition network is 0.87 pixels. Among the 30 patients, the AI-based algorithm group had a complete coincidence rate of 96.7% and the Orthoview group had a complete coincidence rate of 73.3%. The difference was statistically significant ( χ2=6.405, P=0.011). Conclusion:The artificial intelligence-based algorithm can segment the CT image series and identify the feature points of the patient's hip accurately. Compared with the conventional 2D preoperative planning method, the AI-based algorithm is relatively more accurate. This artificial intelligence-based 3D preoperative software has promising prospect to makeaccurate surgical plan efficiently.

Objective:To explore the radiology and short-term clinical outcomes of MAKO robotic-assisted total hip arthroplasty (THA).Methods:The present study retrospectively reviewed the medical records of 23 patients (32 hips) who diagnosed as osteonecrosis of the femoral head and underwent MAKO THA from August 1st to December 31st, 2018 as MAKO THA group. A total of 23 patients (32 hips) with the same diagnosis underwent manual THA at the same time as conventional THA group. There was no statistical difference between the two groups in terms of gender, affected side, age, height, weight, Body Mass Index (BMI), stage of the Association Research Circulation Osseous (ARCO), preoperative Harris hip score, WOMAC Osteoarthritis Index and limb length discrepancy. The patients in both groups were operated by the same doctors. The MAKO THA group underwent the acetabular preparation and the acetabular shell impaction with the assistance of the robotic arm. The leg length and offset were adjusted under the feedback of the MAKO system. Other intraoperative procedures and postoperative interventions of MAKO THA group were similar as conventional THA group. The operation duration, incidence of complications, the radiograph parameters (version, leg length discrepancy and offset), consistency of acetabular prosthesis position in MAKO operation plan, position in postoperative X-ray, the consistency of acetabular prosthesis inclination, version in MAKO operation plan, angles in postoperative CT and functional scores (Harris hip score, WOMAC Osteoarthritis Index and forgotten joint score) at 6 months and 12 months after operation were compared between the two groups.Results:The operation duration of the MAKO THA group was longer than that of the conventional THA group (101.2±19.9 min, 65.5±5.6 min, t=7.659, P<0.001). In terms of radiograph parameters, the different of version (22.63°±5.58°, 15.98°±7.13°, t=4.156, P<0.001) and limb length discrepancy (0.35±0.30 cm, 0.87±0.43 cm, t=4.775, P<0.001) and offset (0.27±0.19 cm, 0.49±0.16 cm, t=4.155, P<0.001) between the two groups were statistically significant. The MAKO operative plan and postoperative radiographs were measured. The difference of inclination/version were 1.18°±2.52°/2.06°±2.79° ( r=0.846, P<0.001; r=0.810, P<0.001), respectively. The horizontal/vertical directions of the joint rotation center were 2.25±1.08 mm and 2.20±1.28 mm ( r=0.975, P<0.001; r=0.974, P<0.001), respectively. In terms of functional results at 6 months and 12 months after operation, Harris hip score in MAKO THA group and in conventional THA group was 90.2±5.40/89.9±5.23 ( t=0.188, P=0.851) and 93.9±2.31/94.0±2.61 ( t=0.254, P=0.801), respectively. The WOMAC index was 27.3±10.36/29.1±12.03 ( t=0.623, P=0.535) and 16.4±8.39/15.2±8.35 ( t=0.597, P=0.552). The forgotten joint score was 76.3±6.11/73.7±6.84 ( t=1.560, P=0.124) and 81.7±4.52/80.7±5.11 ( t=0.816, P=0.418), respectively. Transient bleeding in the anterior superior iliac spine pin holes were reported in 4 hips after discharge in MAKO THA group, which were healed after dressing change. No other intraoperative or postoperative complication was reported. Conclusion:Robotic-assisted THA were more accurate and stable than conventional THA. The version of robot-assisted THA was closer to the target of 20° with similar discrepancy in leg length and hip offset. The short-term functional outcomes were similar in the two groups. However, the operation duration of robot-assisted THA was prolonged.

Objective To investigate the effect of microRNA-134-5p (miR-134-5p) targeting epidermal growth factor receptor (EGFR) on the growth of ovarian cancer cells.Methods The ovarian cancer cell lines SKOV3 and A2780 served as the study objects and were divided into the control group (transfecting miR-NC) and experimental group (transfecting miR-134-5p) according to the treatment method.The expression levels of EGFR gene and downstream target protein were detected by qRT-PCR and western blot.The cell cycle distribution and apoptosis were detected by flow cytometry.The proliferation ability of ovarian cancer cells was detected by MTT assay and colony forming assay.Results The expressions of EGFR and downstream target protein in the experimental group were significantly down-regulated.EGFR mRNA in SKOV3 cells was downregulated to 48％ (P＜0.05),and EGFR mRNA in A2780 cells was down-regulated to 47％ (P＜0.05).The cell cycle of cells in the experimental group was significantly inhibited (P＜0.05),and miR-134-5p induced apoptosis through the EGFR target protein (P＜0.05).The proliferation activity and colony forming ability of the experimental group were significantly inhibited (P＜0.05).Conclusion miR-134-5p could promote the cellular cycle arrest and apoptosis,and reduces the proliferation ability of ovarian cancer cells by targetedly inhibiting the EGFR gene.

OBJECTIVE:To observe therapeutic efficacy and safety of cinobufacini capsules combined with paclitaxel and cisplatin in the treatment of middle and advanced cervical cancer.METHODS:A total of 92 patients with middle and advanced cervical cancer were randomly divided into observation group (46 cases) and control group (46 cases).Both groups received pelvic intensity-modulated radiotherapy (IMRT)+interstitial brachytherapy.Control group was additionally given Paclitaxel injection 135 mg/m2,d1+Cisplatin injection 75 mg/m2,d1,21 d as a treatment course,and received chemotherapy for 2 cycles since the fnrst day of radiotherapy.Observation group was additionally given Cinobufacini capsules 0.5 g orally since the first day of radiotherapy,3 times a day,until the end of radiotherapy.Clinical efficacies as well as platelet count,KPS score,body weight,pain relief and the recovery of platelet abnormality were observed in 2 groups,and the occurrence of toxic reaction was recorded.RESULTS:The complete remission rate,the rate of platelet count abnormality recovery as well as remission rate and total remission rate of pain after 3 weeks of treatment in observation group were significantly higher than control group,with statistical significance (P＜0.05).There was no statistical significance in the total response rate and remission rate after 4,5 weeks of treatment between 2 groups (P＞0.05).After treatment,platelet count of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;KPS score of 2 groups and body weight of observation group were significantly higher than before treatment;body weight of control group was significantly lower than before,and the observation group was significantly higher than the control group,with statistical significance (P＜0.05).The incidence of grade Ⅲ-Ⅳ neutropenia,nausea and vomiting,grade Ⅰ-Ⅱ diarrhea in observation group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:Based on conventional treatment,cinobufacini capsules combined with paclitaxel and cisplatin show significantly therapeutic efficacy for middle and advanced cervical cancer,improve blood hypercoagulation and survival quality,relieve pain and reduce the occurrence of toxic reaction.

BACKGROUND:Hidden blood loss, after total knee arthroplasty, attracts surgeons’ attention. There are various hypotheses about etiopathogenisis of hidden blood loss, but no one can reasonably explain its mechanism. OBJECTIVE:To research the correlation of free fatty acids and hidden blood loss after total knee arthroplasty, and explore the etiology and mechanism of hidden blood loss after total knee arthroplasty. METHODS:Clinical data of 42 osteoarthritis patients who underwent primary unilateral total knee arthroplasty were colected in this study. Intraoperativeand postoperative dominant blood loss was recorded. Blood samples were colected preoperatively and 24, 48, 72, and 96 hours postoperatively. Changes in hemoglobin, erythrocyte count, hematocrit and free fatty acids were detected in blood. Hidden blood loss was obtained by Gross equation. Simultaneously, stains were added to the blood smear. Changes of cels morphology were observed under a microscope. RESULTS AND CONCLUSION:(1) Hemoglobin and erythrocyte count decreased significantly at 24 and 48 hourspostoperatively, and significant differences were determined as compared with that preoperatively (P< 0.01). (2) Free fatty acids levels increased significantly within 24 hours after surgery, and decreased to preoperative levels at 72 and 96 hours later.Hidden blood loss was also significant at 24 and 48 hours after surgery, which showed positive correlation with free fatty acids content. (3) A plenty of abnormal erythrocytes were observed under the microscope. At 24 and 48 hours postoperatively, erythrocyte shrinkage and damage were mainly presented. At 96 hours, no significant abnormality was found. (4) These results indicated that free fatty acids were strongly associated with postoperative hidden blood loss. Surgeon should pay attention to the fatty droplets which may enter into the circulation in the process of reaming the femoral canal so as to reduce intraoperative total blood loss.

Objective To evaluate the effect of sevoflurane anesthesia on the expression of phosphorylated cAMP response element-binding protein (p-CREB) in the hippocampal neurons of developing rats.Methods Thirty-two healthy male Sprague-Dawley rats, aged 7 days, weighing 10-15 g, were equally and randomly divided into either control group (group C) or sevoflurane anesthesia group (group Sev) using a random number table.Group C inhaled 30％ oxygen for 6 h.Group Sev inhaled 3％ sevoflurane for 6 h.Eight rats in each group were sacrificed immediately after the end of oxygen or sevoflurane inhalation, and the hippocampus was removed for determination of the expression of p-CREB.The rats at ages 2 months underwent Morris water maze test.The rats were then sacrificed, and the hippocampus was removed for determination of the expression of p-CREB by Western blot.Results Compared with group C, the escape latency and swimming distance were significantly prolonged, the frequency of crossing the original platform was decreased, the percentage of the time of staying at the quadrant Ⅱ was decreased, and the expression of p-CREB in hippocampal neurons was down-regulated in group Sev.Conclusion The mechanism of sevoflurane anesthesia-induced neurotoxicity is related to inhibition of p-CREB expression in hippocampal neurons of developing rats.

Objective To evaluate the effects of hydrogen on apoptosis in hippocampal neurons caused by sevoflurane anesthesia in neonatal rats.Methods Forty-eight healthy male Sprague-Dawley rats,aged 7 days,weighing 12-20 g,were randomly divided into 3 groups (n=16 each) using a random number table:control group (group C);sevoflurane anesthesia group (group S);hydrogen group (group H).In C and S groups,the rats inhaled 30％ oxygen and 3％ sevoflurane for 6 h,respectively.In group H,3％ sevoflurane and 2％ hydrogen were inhaled for 6 h.Eight rats in each group were randomly selected and sacrificed at 7 days after birth (after the end of oxygen,sevoflurane or hydrogen inhalation),and the hippocampus was removed for determination of the expression of activated caspase-3 and myelin basic protein by Western blot.At 28 days after birth,8 rats were selected,and Y-maze and Morris water maze tests were performed to evaluate the cognitive function.The total number of entries into each arm,the number of spontaneous alternation,escape latency and time of staying at the platform quadrant were recorded.Results Compared with group C,the percentage of spontaneous alternation was significantly decreased,the escape latency was prolonged,and the time of staying at the platform quadrant was shortened,and the expression of activated caspase-3 was significantly up-regulated,and the expression of myelin basic protein was down-regulated in group S.Compared with group S,the percentage of spontaneous alternation was significantly increased,the escape latency was shorten,and the time of staying at the platform quadrant was prolonged,and the expression of activated caspase-3 was significantly downregulated,and the expression of myelin basic protein was up-regulated in group H.There was no significant difference in the number of entries into each arm in Y-maze test between the three groups.Conclusion Hydrogen can inhibit apoptosis in hippocampal neurons caused by sevoflurane anesthesia in neonatal rats.

Objective To evaluate the changes in the expression of protein interacting with Cα kinase 1 (PICK1) in the spinal cord and dorsal root ganglion (DRG) neurons during remifentanil-induced hyperalgesia in rats with incisional pain.Methods Thirty-two male Sprague-Dawley rats, weighing 240-260 g, aged 42-49 days, were randomly divided into 4 groups (n =8 each) using a random number table: control group (group C) , incisional pain group (group Ⅰ) , remifentanil group (group R), and remifentanil + incisional pain group (group R + Ⅰ).In R and R+Ⅰ groups, remifentanil was infused intravenously for 60 min at the rate of 1.2 p,g · kg-1 · min-1.In C and Ⅰ groups, normal saline was infused intravenously for 60 min at the rate of 0.12 ml · kg-1 · min-1.In Ⅰ and R+Ⅰ groups, the model of incisional pain was established, and remifentanil and normal saline were infused intravenously, respectively, at the same time.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured before normal saline or remifentanil infusion, and at 2, 6, 24, and 48 h after the end of normal saline or remifentanil infusion (T1-4).The rats were sacrificed after the last measurement of pain threshold.The lumbar segment (L4-6) of the spinal cord and left DRGs were removed for determination of the expression of PICKl mRNA (by quantitative real-time reverse transcriptase-polymerase chain reaction) and PICK1 protein (by Western blot).Results Compared with group C, the MWT was significantly decreased, the TWL was shortened, and the expression of PICK1 protein and mRNA was up-regulated in R and R+Ⅰ groups, and the MWT was significantly decreased, the TWL was shortened (P＜0.05) , and no significant change was found in the expression of PICK1 protein and mRNA in group Ⅰ (P＞0.05).Compared with group Ⅰ, the MWT was significantly decreased, the TWL was shortened, and the expression of PICK1 protein and mRNA was up-regulated in group R+Ⅰ (P＜0.05).Compared with group R, the MWT was significantly decreased, the TWL was shortened (P＜0.05) , and no significant change was found in the expression of PICK1 protein and mRNA in group R+ Ⅰ (P＞0.05).Conclusion The mechanism by which remifentanil induces hyperalgesia may be related to up-regulation of PICK1 expression in the spinal cord and DRG neurons of rats with incisional pain.

Objective To investigate the mechanisms of radiotherapy sensitization role of curcumin in cervical carcinoma Hela cells.Methods Western blot was used to detect expressions of p53, p21, Bax,and Bcl-2 proteins after cervical cancer Hela cells were treated.Results The expressions of p53 and p21 proteins were increased.The ratio of Bcl-2/Bax was decreased when curcumin and irradiation were applied to cells alone (P ＜ 0.05).This change were much more obvious when irradiation and curcumin were combined than either of them was used alone(P ＜0.01).Conclusions The mechanisms of curcumin enhancing radiosensitivity on Hela cells might be due to upregulation of p53, p21, and Bax proteins and downregulation of Bcl-2 protein.

Objective To explore the effect of acupuncture treatment combined with specific nursing intervention on the intestinal function recovery in the gastrointestinal tumor patients after operation .Methods Eighty patients with gastrointestinal tumor were divided into the control group and the intervention group according to the random number table , each with 40 cases.The control group including the patients and their family received the routine education of perioperative nursing the day before surgery , and also received the acupuncture treatment including bilateral acupuncture point injection of vitamin B 1 at Zusanli ( 100 mg/d ) and bilateral electro-acupuncture at Zusanli and Neiting twice daily after the operation .The intervention group received the specific nursing intervention on the basis of control group .The times of first anal exhaust , bowel movement and removal of nasogastric tube , and the incidence rate of abdominal distention were compared between two groups . Results The times of first anal exhaust , bowel movement and removal of nasogastric tube were respectively (47.90 ±6.16),(58.90 ±10.68),(24.52 ±8.45) h in the intervention group, and were shorter than (52.62 ± 9.46),(65.46 ±13.56),(31.38 ±9.50) h in the control group, and the differences were statistically significant (t=2.64,2.40,3.41, respectively;P<0.05).The incidence rate of abdominal distention was 5%in the intervention group , and was lower than 20.0% in the control group , and the difference was statistically significant (χ2 =4.11,P <0.05).Conclusions The acupuncture treatment combine with specific nursing intervention can effectively promote the intestinal function recovery in the gastrointestinal tumor patients after operation.