BACKGROUND:Scaphoid fractures are common wrist fractures.The percutaneous screw is used to treat scaphoid fractures.The closed reduction of the fracture site,the precise placement of the hollow compression screw in the scaphoid axis and the compression fixation of the fracture site can promote fracture healing and achieve the better function of the wrist. OBJECTIVE:To evaluate the efficacy of percutaneous hollow compression screw fixation of scaphoid fractures using a novel Kirschner wire guide. METHODS:Between January 2015 and December 2020,clinical data from 15 patients with scaphoid fractures selected at the Department of Hand Surgery,Third Hospital of Hebei Medical University were retrospectively analyzed.All patients underwent percutaneous hollow compression screw fixation by a novel Kirschner wire guide.Fracture healing time,operation time,number of intraoperative fluoroscopies,time to return to work and complications were collected.According to the modified Mayo wrist scoring system,the functional outcomes of wrists were assessed 12 months after surgery.Wrist flexion,extension,ulnar deviation,radial deviation and grip strength were measured. RESULTS AND CONCLUSION:All patients were followed up for 12 months.The compression screw was located in the axial position of the scaphoid by routine immediate postoperative radiographs.All scaphoid fractures united at an average of 10.0 weeks.The average operation time was 55.7 minutes.The number of intraoperative fluoroscopies was 10.9.The average time to return to work was 10.3 weeks.The results of wrist joint function were excellent in 9 cases,good in 5 cases,and average in 1 case,with an excellent and good rate of 93.3%.No significant differences in wrist flexion,extension,ulnar deviation,radial deviation and grip strength were found between the affected and healthy sides(P＞0.05).None of the patients had wound infection,malunion,screw displacement,or screw breakage.These findings indicate that the application of a novel guide can shorten the operation time,reduce the number of intraoperative fluoroscopies,improve the accuracy of screw insertion,and shorten the time to return to work.The function of the wrist was satisfactory after the operation.The novel Kirschner wire guide made percutaneous hollow compression screw fixation easier for scaphoid fractures.

Intelligent medical devices are flourishing with the deep integration of modern information and artificial intelligence technologies into healthcare.Testing is an important means of performance evaluation and quality control for intelligent medical devices.Compared with traditional medical devices,the testing methods and technologies of intelligent medical devices are still immature,and need active research to promote the progress in this area.Intelligent medical devices are classified according to their characteristics as artificial intelligence medical devices in the form of software and medical robots based on a general discussion of their development.The medical-device Internet of Things(IoT)system has also been included due to its close relation to the construction of smart hospitals.For each type of intelligent medical device,testing indexes and testing plans are discussed.It is suggested that specific test rules should be further developed for various specific devices.Besides,the evaluation method of complex intelligent systems should be introduced and real-world data should be used for evaluation.This paper aims to accelerate the development of intelligent medical device testing,laying the foundation for quality control and performance evaluation of intelligent medical devices.

Internet of Things (IoT) technology plays an important role in smart healthcare. This paper discusses IoT solution for emergency medical devices in hospitals. Based on the cloud-edge-device architecture, different medical devices were connected; Streaming data were parsed, distributed, and computed at the edge nodes; Data were stored, analyzed and visualized in the cloud nodes. The IoT system has been working steadily for nearly 20 months since it run in the emergency department in January 2021. Through preliminary analysis with collected data, IoT performance testing and development of early warning model, the feasibility and reliability of the in-hospital emergency medical devices IoT was verified, which can collect data for a long time on a large scale and support the development and deployment of machine learning models. The paper ends with an outlook on medical device data exchange and wireless transmission in the IoT of emergency medical devices, the connection of emergency equipment inside and outside the hospital, and the next step of analyzing IoT data to develop emergency intelligent IoT applications.
Internet of Things ; Reproducibility of Results ; Internet ; Machine Learning ; Technology

Hilar cholangiocarcinoma (HCCA) is a type of bile duct cancer with insidious onset and poor prognosis. Surgical resection is the only potentially curative treatment. The selection of surgical approaches and prognosis assessment depend on different classification systems and preoperative imaging results. This article reviews the progress in classification systems, imaging modalities, biliary drainage techniques, postoperative adjuvant therapy, future liver remnant insufficiency treatment, liver transplantation and resection extent for HCCA.

Objective To investigate the exposure difference of different dosage forms of mycophenolic acid (MPA) between children aged ≤12 and > 12 years old after kidney transplantation. Methods Clinical data of 73 children undergoing kidney transplantation from donation after cardiac death (DCD) were retrospectively analyzed. Postoperative immunosuppressive regimen was MPA+ tacrolimus+glucocorticoid. According to different dosage forms of MPA, all recipients were divided into group A (n=37, mycophenolate mofetil capsules), group B (n=28, enteric-coated mycophenolate sodium) and group C (n=8, mycophenolate mofetil dispersible tablets). All children were divided into ≤12 and > 12 years old groups according to the age of kidney transplantation. The daily dosage of different dosage forms was calculated. The blood concentration (C) of MPA and the area under the curve (AUC) were detected by enzyme-multiplied immunoassay technique. The MPA blood concentration was statistically compared between two age groups at different time points. The recovery of renal function and postoperative complications were assessed. Results No significant differences were observed in the dosage and blood concentration of drug at different time points among groups A, B and C (all P > 0.05). The MPA-C_{4 h} and AUC in the ≤12 years old group were significantly higher than those in the > 12 years old group (both P < 0.05). In group B, the MPA-C_{4 h} of children aged ≤12 years old was significantly higher compared with that in those aged > 12 years old (P=0.016). The MPA-C_{4 h} of children aged ≤12 years old in group B was higher than those in group A and group C, but the differences were not statistically significant (P=0.080). There was no significant difference in the incidence of acute rejection and infection among three groups (both P > 0.05). Conclusions Children of different ages who are given with different dosage forms of MPA after kidney transplantation obtain different exposure rates. The exposure rate of kidney transplant recipients aged ≤12 years old tends to be higher than that of their counterparts aged > 12 years old, mainly seen in the recipients treated with enteric-coated mycophenolate sodium. Therefore, it is necessary to monitor the exposure level of MPA, which provides significant guidance for adjusting the drug dosage of different dosage forms.

Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.

Objective:To summarize the preliminary experience of percutaneous radiofrequency ablation(RFA) in the treatment of early breast cancer(the length of the lesion<15 mm) with negative sentinel lymph node(SLN), and to evaluate its feasibility and efficacy.Methods:From October 2016 to November 2019, 18 patients with early breast cancer(the length of the lesion<15 mm) treated in the First Affiliated Hospital of Zhengzhou University underwent FNAC of axillary SLN under the guidance of CEUS were enrolled. Patients with pathologically negative axillary SLN were treated with percutaneous RFA of breast cancer. The complete ablation rate and the relapse rate were evaluated. Intraoperative pain, postoperative complications and postoperative patient satisfaction were analyzed.Results:Eighteen patients underwent CEUS-guided FNAC of SLN, of which 1 case was positive and 17 cases were negative. Seventeen breast cancer lesions of the 17 negative patients underwent percutaneous RFA. The length of the lesions was 3.3-14.0 (8.2±3.9)mm, the complete ablation rate was 100%, the ablation time was 9-18 (12.8±2.7)min. During the follow-up of 9-46 months, no patient developed tumor progression. There were no serious complications related to RFA after operation. The patients′ satisfactory rate for postoperative appearance was 100%.Conclusions:RFA of early breast cancer(the length of the lesion<15 mm) with negative SLN is feasible and has the advantages of safety, minimal invasion and beauty.

Objective To investigate the early resuscitation effect of hemoglobin-based oxygen carriers (HBOC) in rats with uncontrolled hemorrhagic shock.Methods 170 Sprague-Dawley (SD) rats were randomly divided into five groups:lactate Ringer solution (LR) control group,whole blood control group,and 0.5％,2.0％,5.0％ HBOC groups,with 34 rats in each group.The uncontrolled hemorrhagic shock model in SD rats was reproduced by cutting off the splenic artery branch,and induced mean arterial pressure (MAP) reducing to 40 mmHg (1 mmHg =0.133 kPa).The corresponding solution was infused after model reproduction in each group,maintaining MAP at 50 mmHg for 1 hour,then completely ligating and hemostasis,and maintaining MAP at 70 mmHg for 1 hour and 80 mmHg for 1 hour respectively,after maintaining MAP 80 mmHg,all were supplemented with LR to 2 times blood loss volume.The survival rate and blood loss rate were observed in 16 rats in each group,hemodynamics parameters including MAP,left ventricular systolic pressure (LVSP) and the maximum rate of left ventricular pressure rise (+dp/dtmax) were determined in another 10 rats,and cardiac output (CO) and tissue oxygen supply (DO2) were observed in the rest 8 rats.Results ① When resuscitation by LR alone,the blood loss rate of animals was as high as 60％ to 70％.Compared with the LR control group,whole blood recovery could significantly reduce the blood loss rate before hemostasis in uncontrolled hemorrhagic shock rats [(46.6 ± 4.5)％ vs.(62.3 ± 4.0)％,P ＜ 0.01];0.5％,2.0％,5.0％ HBOC could significantly decrease the blood loss rate,especially in 5.0％ HBOC group with significant difference as compared with that in the LR control group [(45.6±4.1)％ vs.(62.3±4.0)％,P ＜ 0.01].② When LR was used alone for resuscitation,the rats died quickly and survived for a short time.Only one rat survived for 12 hours,and no rat survived for more than 24 hours.Compared with the LR control group,whole blood resuscitation could improve the survival rate of uncontrolled hemorrhagic shock rats,and the survival time was significantly prolonged (hours:20.4± 4.6 vs.3.5 ± 1.1,P ＜ 0.01);0.5％,2.0％ and 5.0％ HBOC also significantly prolonged the survival time of rats.The 5.0％ HBOC group had the best effect,4 rats survived in 24 hours,and the survival time was significantly longer than that of the LR control group (hours:18.4 ± 4.0 vs.3.5 ± 1.1,P ＜ 0.01),and it was the same as the whole blood control group.③ Compared with pre-shock,CO,DO2 and hemodynamic parameters of uncontrolled hemorrhagic shock rats were significantly decreased,and the above parameters were gradually increased with the prolongation of rehydration time.Compared with the LR control group,whole blood resuscitation could significantly increase CO and DO2,and improve hemodynamics in rats with uncontrolled hemorrhagic shock at different time points.Three concentrations of HBOC could also increase CO,DO2 and other hemodynamic parameters of rats at 1 hour of maintaining MAP of 80 mmHg after hemostasis and 1 hour and 2 hours after resuscitation.The effect of 5.0％ HBOC group was more significant than that of the LR control group with statistically significant difference [CO (× 10-3,L/min):72.84±2.84 vs.63.11±2.38 at 1 hour of maintaining MAP of 80 mmHg,70.25±4.55 vs.59.88 ± 9.31 at 1 hour after resuscitation,71.51 ± 2.90 vs.53.24 ± 6.32 at 2 hours after resuscitation;DO2 (L· min-1 · m-2):271.9± 13.5 vs.159.1 ±25.4 at 1 hour of maintaining MAP of 80 mmHg,261.0± 15.0 vs.145.7±20.1 at 1 hour after resuscitation,249.6± 12.0 vs.107.4± 18.2 at 2 hours after resuscitation;MAP (mmHg):82.1±2.1 vs.74.0±2.8 at 1 hour of maintaining MAP of 80 mmHg,107.5±9.3 vs.64.0±5.7 at 1 hour after resuscitation,104.0±9.7 vs.73.0±4.2 at 2 hours after resuscitation;LVSP (mmHg):128.6±7.9 vs.103.8±0.8 at 1 hour of maintaining MAP of 80 mmHg,129.3±± 15.0 vs.99.4±0.0 at 1 hour after resuscitation,127.5± 11.3 vs.97.4±0.0 at 2 hours after resuscitation;+dp/dt max (mmHg/s):6 534.2±± 787.6 vs.5 074.0± 71.7 at 1 hour of maintaining MAP of 80 mmHg,5 961.5 ±± 545.4 vs.4 934.5 ± 510.2 at 1 hour after resuscitation,5 897.4± 350.5 vs.4 534.7 ±489.2 at 2 hours after resuscitation,all P ＜ 0.05].Conclusions HBOC infusion prolonged the survival time,increased survival rate,and improved hemodynamics,cardiac function and tissue oxygen supply in a dose-dependent manner in the early stage of uncontrolled hemorrhagic shock.The recovery effect of 5.0％ HBOC was similar to that of the whole blood.

In this study, the mobilomes of nine teleost species were annotated by bioinformatics methods. Both of the mobilome size and constitute displayed a significant difference in 9 species of teleost fishes. The species of mobilome content ranking from high to low were zebrafish, medaka, tilapia, coelacanth, platyfish, cod, stickleback, tetradon and fugu. Mobilome content and genome size were positively correlated. The DNA transposons displayed higher diversity and larger variation in teleost (0.50% to 38.37%), was a major determinant of differences in teleost mobilomes, and hAT and Tc/Mariner superfamily were the major DNA transposons in teleost. RNA transposons also exhibited high diversity in teleost, LINE transposons accounted for 0.53% to 5.75% teleost genomic sequences, and 14 superfamilies were detected. L1, L2, RTE and Rex retrotransposons obtained significant amplification. While LTR displayed low amplification in most teleost with less than 2% of genome coverages, except in zebrafish and stickleback, where LTR reachs 5.58% and 2.51% of genome coverages respectively. And 6 LTR superfamilies (Copia, DIRS, ERV, Gypsy, Ngaro and Pao) were detected in the teleost, and Gypsy exhibits obvious amplication among them. While the SINE represents the weakest ampification types in teleost, only within zebrafish and coelacanth, it represents 3.28% and 5.64% of genome coverages, in the other 7 teleost, it occupies less than 1% of genomes, and tRNA, 5S and MIR families of SINE have a certain degree of amplification in some teleosts. This study shows that the teleost display high diversity and large variation of mobilome, there is a strong correlation with the size variations of genomes and mobilome contents in teleost, mobilome is an important factor in determining the teleost genome size.

Objective To investigate the effects of hydrochloride fasudil on inflammation and secondary brain injury in rats after intracerebral hemorrhage (ICH).Methods One hundred and seventeen male Wistar rats were randomly divided into normal group (n=9),sham-operated group (n=36),ICH group (n=36) and hydrochloride fasudil treatment group (ICH/HF,n=36).ICH was caused by injecting non-anticoagulant autologous arterial blood into the right caudate nucleus,3 mg HF was dissolved in 2 mL 0.9％ saline solution and administrated intraperitioneally once daily (12 mg/kg/d) since 12 h ofICH onset.Rats in the sham-operated group and ICH group received an equal volume of normal saline.On one,3,7 and 14 d ofICH induction,Bederson method was used to score neurological deficits in rats;interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels in serum were detected by enzyme-linked immunosorbent assay (ELISA).Brain edema was measured by comparing wet and dry brain weights.Inflammatory cell infiltration around the hematoma was visualized using hematoxylin and eosin,and changes in neuronal morphology were detected by Nissl staining.Immunohistochemistry method was used to detect the expressions of Caspase-3 and Bcl-2.Results (1) The neurological deficit scale scores on one and 3 d ofICH in the ICH/HF group were significantly decreased as compared with those in the ICH group (P＜0.05).(2) Serum IL-6 (except 14 d of ICH) and TNF-α levels in ICH/HF group were significantly decreased as compared with those in the ICH group (P＜0.05).(3) Brain water contents at each time point in ICH/HF group were significantly decreased as compared with those in the ICH group (P＜0.05).(4) HE staining showed the sizes of hematoma on one and 3 d ofICH in the ICH/HF group and ICH group were consistent;but ICH/HF group had smaller hematomas on 7 d of ICH,and disappeared hematoma and glial cell hyperplasia on 14 d of ICH.Mass neutrophils infiltration developed in the perihematomal areas of the ICH and ICH/HF groups;however,neutrophils infiltration in the ICH/HF group ([20.56±6.37] cells/field) was significantly decreased as compared with that in the ICH group ([41.50±8.91] cells/field) on one d of ICH (P＜0.05).(5) Nissl staining showed neuron death and loss in the perihematomal areas on one,3 and 7 d of ICH in the ICH group;but ICH/HF group had significantly increased neuron number as compared with the ICH group (P＜0.05).(6) The Caspase-3 expression on 3 and 7 d ofICH in the ICH/HF group was significantly decreased as compared with that in the ICH group (P＜0.05);the Bcl-2 expressions at each time point in the ICH/HF group was significantly increased as compared with that in the ICH group (P＜0.05).Conclusion HF exerts neuroprotective effects in ICH rat models by decreasing serum IL-6 and TNF-α levels,reducing neutrophils infiltration and neuronal necrosis around the hematoma,restraining the cell apoptosis through down-regulating Caspase-3 and up-regulating expression of Bcl-2,alleviating the brain edema,and improving the neurological outcome.