Objective To establish an automatic review plan for coagulation tests with image recognition function,and evaluate the correctness and effectiveness of the plan.Methods Artificial intelligence software and hardware were combined to establish an image recognition system that could automatically determine the characteristics of specimens,blood volume and hematocrit.The correctness of the determination results of specimen character was compared with the visual method,the correctness of the determination results of blood volume was compared with the manual measurement method,and the correctness of hematocrit was compared with the hematology analyzer.According to the flow chart,reference interval,medical decision level,critical value range,relevant literature,work experience and historical data,the autoverification rules of coagulation tests were formulated.The autoverification rules were manually verified,and the autoverification pass rate,true positive rate,true negative rate,false positive rate,and false negative rate were calculated.The change of turnaround time in the laboratory after the implementation of the autoverification scheme was evaluated.Re-sults The accuracy rate of sample trait determination in the image recognition system was 96.72％,and the false negative rate of judging hemolytic,jaundice,and lipoid blood samples as normal samples was 0.04％.The image recognition system was compared with the blood volume data of two groups of specimens measured manually,P=0.4881.The image recognition method was not inferior to the manual measurement method.Comparing the two sets of hematocrit data from the image recognition system and the blood cell analyzer,P=0.1130,the image recognition system was not inferior to the blood cell analyzer.A total of 61 automatic re-view rules for coagulation tests had been established,including numerical abnormalities,logical abnormalities,Delta Check,sample quality abnormalities,reaction curve abnormalities,etc.The automatic review pass rate was 76.19％,true positive rate was 23.77％,true negative rate was 76.19％,false positive rate was 0.04％,and false negative rate was 0.00％.After implementing the automatic audit plan,the turnaround time of sam-ples in each quantile was shortened,with an average shortening time of 13.66 min.Conclusion The applica-tion of image recognition technology in the automatic review of coagulation tests makes the automatic review function more automated and scientific,standardizes specimen quality judgment,improves the accuracy of test results,effectively improves work efficiency and saves manpower.

Background::There is a need for effective and safe therapies for psoriasis that provide sustained benefits. The aim of this study was to assess the efficacy and safety of tildrakizumab, an anti-interleukin-23p19 monoclonal antibody, for treating moderate-to-severe plaque psoriasis in Chinese patients.Methods::In this multi-center, double-blind, phase III trial, patients with moderate-to-severe plaque psoriasis were enrolled and randomly assigned (1:1) to receive subcutaneous tildrakizumab 100 mg or placebo at weeks 0 and 4. Patients initially assigned to placebo were switched to receive tildrakizumab at weeks 12, 16, and every 12 weeks thereafter. Patients in the tildrakizumab group continued with tildrakizumab at week 16, and every 12 weeks until week 52. The primary endpoint was the Psoriasis Area and Severity Index (PASI 75) response rate at week 12.Results::At week 12, tildrakizumab demonstrated significantly higher PASI 75 response rates (66.4% [73/110] vs. 12.7% [14/110]; difference, 51.4% [95% confidence interval (CI), 40.72, 62.13]; P <0.001) and Physician’s Global Assessment (60.9% [67/110] vs. 10.0% [11/110]; difference, 49.1% [95% CI, 38.64, 59.62]; P <0.001) compared to placebo. PASI 75 response continued to improve over time in both tildrakizumab and placebo-switching to tildrakizumab groups, reaching maximal efficacy after 28 weeks (86.8% [92/106] vs. 82.4% [89/108]) and maintained up to 52 weeks (91.3% [95/104] vs. 87.4% [90/103]). Most treatment-emergent adverse events were mild and not related to tildrakizumab. Conclusion::Tildrakizumab demonstrated durable efficacy through week 52 and was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis.Trial registration::ClinicalTrials.gov, NCT05108766.

The cartilage-protective effect of ginkgolide C(GC)on the two modeling modalities was investigated based on joint pain,degree of cartilage pathology,ECM degradation process,and level of inflammatory mediator production in rats.Twenty-five SD rats were selected and randomly di-vided into five groups:the control group(Control group),model 1 group(ACLT group),adminis-tration 1 group(ACLT+GC group),model 2 group(MIA group),and administration 2 group(MIA+GC group.)The rats were euthanized after 4 weeks of the test.Femur,tibia and blood samples were collected from the right hind limb of rats.The degree of pathology in the femur and tibia of rats was assessed by saffron O solid green staining and OARSI score.Immunohistochemis-try was used to detect the expression levels of collagen Ⅱ and MMP-13 in cartilage.ELISA was used to detect the changes in the levels of MMP-3,MMP-13,CTX-Ⅱ,COMP,COX-2,INOS,IL-1β,and TNF-α in the serum of rats.Cold sensitivity test and knee extension vocalization test were conducted to detect the degree of joint pain in rats.ACLT could cause more severe structural dam-age to articular cartilage compared with the MIA group.The OARSI scores and the expression of MMP-13 in femur and tibia,and the serum levels of MMP-13,MMP-3,CTX-Ⅱ,and COMP were higher in the ACLT group than those in the MIA group.However,the levels of inflammatory me-diators COX-2,IL-1β,and TNF-α were significantly lower in the ACLT group than in the MIA group(P＜0.0l).GC intervention reduced the OARSI score(P＜0.05 or P＜0.01)and pain scores,inhibited the ECM matrix degrading enzymes(MMP-13,MMP-3),cartilage metabolism markers(CTX-11,COMP),and inflammatory mediators(COX-2,INOS,IL-1β and TNF-α)ex-pression,and promoted collagen Ⅱ synthesis.Both modeling methods resulted in cartilage damage.In particular,the OA model constructed by ACLT+PMMx method in rats had obvious joint dam-age,which was favorable to investigate the degree of cartilage structural damage.GC attenuated cartilage pathological changes,pain severity and inflammatory response in the rat OA model in both groups,thus exerting a cartilage-protective effect.

Objective Using healthy female reproductive-age rhesus macaques as the research subjects,we explored the correlation between menstrual cycle abnormalities and gut microbiota composition by using 16S rRNA metagenomic sequencing.Methods Twenty-seven healthy female rhesus macaques were divided into regular menstrual and irregular menstrual groups.Fecal samples were collected at follicular phase(FP),ovulation phase(OP)and luteal phase(LP)of the two groups.The structure and diversity of bacterial flora in different physiological periods were analyzed and compared between the two groups.Results At the phylum level,Firmicutes,Bacteroidetes,and Proteobacteria dominated the sample flora in the follicular,luteal,and ovulatory phases of the rhesus macaques in both the regular and irregular groups,with a combined percentage of more than 98% .At the genus level,the genus Prevotella_9,Ruminococcaceae_UCG-002,Lactobacillus,Prevotella_2,Phascolarctobacterium,Ruminococcaceae_UCG-005,Streptococcus,Blautia,Prevotellaceae_NK3B31_group,Rikenellaceae_RC9_gut_group were dominant.In the luteal phase the percentage of Firmicutes was higher in the regular group than in the irregular group,while the opposite was true for Bacteroidetes.Spirochaetes were higher in the regular group than in the irregular group at all 3 stages(P＜0.05).Conclusion There were some differences in intestinal microbial composition between the two groups of macaques with regular and irregular menstrual cycles,which provided some reference for the study of intestinal bacteria and ovulation disorders.

Objective:To explore the clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus for chronic bifurcate ligament injury.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with chronic bifurcate ligament injury who had been treated by anatomical reconstruction with the autologous semitendinosus from March 2018 to January 2021 at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan. There were 4 males and 8 females with an age of (41.4±9.6) years. Seven left and 5 right feet were affected; the time from injury to surgery was (9.3±4.3) months. The surgical efficacy was evaluated based on anteroposterior and lateral imaging assessments of foot weight-bearing at 6 months postoperation, comparison of the visual analogue scale (VAS) pain scores for foot weight-bearing walking and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores between preoperation and the last follow-up, stress test for stability of the transverse tarsal joint, recovery of movement, and occurrence of complications.Results:All patients were followed up for (18.4±4.0) months. Their sports activities were completely resumed after postoperative (6.8±3.9) months. Primary wound healing was achieved in all patients. One patient suffered from cutaneous nerve lesion and skin numbness, the symptoms of which disappeared after conservative treatment. Double harmonic curves were observed on the anteroposterior and lateral imaging films of foot weight-bearing in all patients. The spaces in the calcaneocuboid and the calcaneonavicular joints were normal, the articular positions were matched, and the calcaneocuboid joint was stable without recurrence or worsening of displacement. The VAS decreased significantly from preoperative 6.5 (5.6, 7.0) to 0.0 (0.0, 1.0) at the last follow-up, and the AOFAS mid-foot score increased significantly from preoperative (55.6±8.8) points to (92.3±2.6) points at the last follow-up ( P<0.05). The stress test for the stability of the transverse tarsal joint showed joint stability. Conclusion:Reconstruction of the calcaneocuboid and calcaneonavicular ligaments using the autologous semitendinosus is an alternative treatment for patients with chronic bifurcate ligament injury, because it can restore the stability of the bifurcate ligament and obviously improve the foot and ankle functions with limited postoperative complications.

Objective:To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods:Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019. All 4 cases were cardiac death donors. There were 3 males and 1 female donors, aged (54 ± 22.69) d and weighing (5.6 ± 0.79) kg. There were 1 male and 3 female recipients, aged (41.5 ± 5.97) years and weighing (45 ± 3.56) kg. For lowering operative difficulties and preventing hemodynamic disturbances, bilateral kidneys were sutured and fixed during trimming. Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results:All operations were successful without vascular or urinary complication. The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min. The functions of transplanted kidney recovered well during a follow-up period of 12 months. The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions:The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling. With a higher success rate, vascular complications are lowered. A wider popularization is recommended.

Objective:To evaluate the role of microRNA-21 (miR-21) in sepsis-induced lung injury and the relationship with transient receptor potential melastatin 2 (TRPM2) expression in rats.Methods:Forty-eight clean-grade Wistar rats, half male and half female, weighing 250-300 g, were divided into 4 groups ( n=12 each) by a random number table method: sham operation group (SH group), sepsis group (S group), miR-21 inhibitor group (group MI), and miR-21 inhibitor plus TRPM2 blocker Gd3 + group.Sepsis was induced by cecal ligation and puncture (CLP) in anesthetized rats.In MI group and MIG group, miR-21 inhibitor and miR-21 inhibitor plus TRPM2 blocker Gd3 + were injected through the tail vein, respectively, at 12 h before CLP.Carotid artery blood samples were collected at 24 h after CLP for blood gas analysis, PaO 2 was recorded, and oxygenation index was calculated.Animals were sacrificed, and lung tissues were removed for microscopic examination of the pathological changes which were scored and for determination of wet to dry weight ratio (W/D ratio), expression of miR-21 and TRPM2 mRNA (quantitative real-time polymerase chain reaction), levels of malondialdehyde (MDA) and superoxide dismutase (SOD) (by spectrophotometer colorimetry) and levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) in serum (by enzyme-linked immunosorbent assay). Results:Compared with group SH, the oxygenation index and SOD activity were significantly decreased, and W/D ratio, lung injury score, MDA content, serum IL-6, IL-8 and TNF-α concentrations were increased in the other three groups, and the expression of miR-21 mRNA was up-regulated, and the expression of TRPM2 mRNA was down-regulated in group S ( P<0.05). Compared with group S, the oxygenation index, SOD activity and serum IL-6, IL-8 and TNF-α concentrations were significantly increased, and W/D ratio, lung injury score and MDA content were decreased in group MI, and the expression of miR-21 mRNA was down-regulated, and the expression of TRPM2 mRNA was up-regulated in MI and MIG groups ( P<0.05). Compared with group MI, the oxygenation index and SOD activity were significantly decreased, W/D ratio, lung injury score, MDA content, serum IL-6, IL-8 and TNF-α concentrations were increased, and the expression of TRPM2 mRNA was down-regulated in group MIG ( P<0.05). Conclusion:Up-regulated expression of miR-21 and down-regulated expression of TRPM2 are involved in the process of sepsis-induced lung injury in rats.

Objective: To investigate the value of CT wavelet texture analysis based on primary tumor of papillary thyroid carcinoma (PTC) in predicting central lymph node metastasis (CLNM). Methods: A retrospective analysis was performed to 250 patients (307 nodules) who pathologically confirm with PTC in the First Affiliated Hospital of Kunming Medical University from December 2013 to August 2019. Thyroid dual phase scanning was performed in all patients within two weeks before surgery. All patients underwent central or total cervical lymph node dissection, among which 160 cases (189 nodules) were classified as training sets, while 90 cases (118 nodules) were in the verification sets. Besides, all patients were divided into CLNM group and no CLNM group according to pathology. The DeepWise software were used to manually delineate PTC primary nodules on venous phase CT images, and 576 wavelet texture features were extracted. The differences of texture feature parameters between the two groups were compared. The top 10 wavelet texture features of the area under curve (AUC) value were manually selected as the best parameters. Multivariable logistic regression analysis was used to establish and verify the model, the optimal cutoff value was found by using receiver operating characteristic curve analysis. Results: Totally 124 features were statistical difference between the two groups. The top 10 characteristic parameters for manual diagnosis with AUC values ranged from 0.599 to 0.630 (P<0.05), multi-collinearity test and multi-logstic regression analysis showed that there was no collinear correlation between the above 10 features, and small-area low-gray emphasis was an independent predictor of risk factors. The AUC value, sensitivity, specificity, and accuracy of the predictive model for the diagnosis of CLNM in the training set were 0.693, 62.84%, 60.47%, 62.96% and validation set were 0.602, 64.95%, 33.33%, and 59.32%, respectively. Conclusion Wavelet texture analysis in CT venous phase may allow detection of CLNM of PTC.

Objective To investigate the feasibility of morphology and quantitative parameters for evaluation of lymph node metastatic (LNM) potential in papillary thyroid microcarcinoma (PTMC) with dual?energy CT iodine image. Methods The ninety?five PTMC patients (59 patients with LNM, 36 patients without LNM in the neck) whom underwent dual?energy contrast scanning and confirmed by first postoperative pathology results were enrolled in this retrospective study from July 2014 to December 2016. Dual?energy iodine images were obtained by the dual?energy post?processing software. The iodine image morphology of each patient was analyzed, including size, number, aspect ratio, shape, uncompleted enhanced ring sign, nodule which breaks through the thyroid capsule, microcalcification, and enhanced?degree, and diagnostic efficiency of each imaging feature was calculated. The iodine concentration (IC) and CT value of PTMC solid parts were measured in arterial phase and venous phase images respectively, as well as the NICnod (normalized iodine concentration) and normalized CT value. The independent sample t test was performed to compare quantitative parameters between the LNM group and non?LNM group. ROC curves with quantitative parameters of two phases were used to analyze the diagnostic efficiencies of NIC and normalized CT value. Results Statistically, in the iodine image, the imaging features of LNM group, including multiple lesions, maximum diameter of nodules, aspect ratio, irregular shape, uncompleted enhanced ring sign, and nodule which breaks through the thyroid capsule, had significant differences compared with those of non?LNM group in the neck (χ2 were 14.965,8.724,11.494,8.097,6.324,23.272;P all<0.05), and there were positive correlations with LNM potential (r were 0.397,0.303,0.348,0.309,0.258, 0.495;P all<0.05), the diagnostic efficiency of nodule which breaks through the thyroid capsule was the highest among the imaging features for diagnosis of cervical LNM (sensitivity 77.9%, specificity 72.2%, accuracy 75.8%). During the artery phase, mean NICROI and normalized CT value of non?LNM group were respectively 0.29±0.10,0.33±0.11,and these of LNM group were respectively 0.45±0.15,0.44±0.13.NICROI and normalized CT value of non?LNM group were less than LNM group′s (t=-4.891,－3.462;P all<0.001). During the venous phase, NICROI and normalized CT value of LNM group were higher than non?LNM group′s (t=-3.381,－2.18;P all<0.05). Among all quantitative parameters, the NIC of arterial phase has the highest diagnostic efficacy for the diagnosis of cervical LNM. The area under the ROC curve (AUC) was the largest, 0.814, the sensitivity was 73.5%, the specificity was 79.2%, and the diagnostic threshold was 0.208. Conclusion Dual?energy CT iodine image morphology and quantitative parameters have important clinical value for evaluation of cervical lymph node metastatic potential in PTMC.

Objective To evaluate the feasibility and efficacy of posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis.Methods From January 2013 to June 2017,a retrospective study was conducted with 21 patients of multi-segmental cervical diseases accompanied cervical lordosis loss,and the complete followup data was obtained.There were 14 males and 7 females,with an average age of 53.9±7.3 years (range,42-65 years).There were 14 multi-segmental cervical spondylotic myelopathy,5 ossification of posterior longitudinal ligament,and 2 congenital cervical stenosis included in this study.The cervical lordotic angle and cervical curvature index were measured preoperatively and 1 year postoperatively.To access the enlargement of spinal canal and spinal cord,the anteroposterior diameter and cross section area of spinal canal or spinal cord were measured on MRI preoperatively and 1 year postoperatively.The Japanese Orthopaedic Association Scores (JOA) was applied to evaluate the neurological function at preoperation and postoperation.Visual Analogue Scales (VAS) was applied to evaluate the pain degree at preoperation and postoperation.Frankel classification was used to assess the severity of spinal cord injury at preoperation and postoperation.Results The follow-up time was 12-26 months,with an average of 16.4 months.The cervical lordosis angle was 3.1°±2.3° preoperatively,and 4.2°±1.6° 1 year postoperatively with a significant difference.The cervical curvature index was 4.4％ ± 1.7 ％ preoperatively and 5.0％ ± 1.5 ％ 1 year postoperatively with no statistically difference.Except for C7T1 level,the preoperative anteroposterior diameter and cross section area of spinal canal at C2.3,C3.4,C4.5,C5.6,and C6.7 level were lower than that at 1 year after operation with a significant difference.Except for C2,3 and C7T1 and level,the preoperative anteroposterior diameter and cross section area of spinal cord at C3,4,C4,5,C5,6,and C6,7 level were significantly lower than that at 1 year after operation.The average JOA score preoperatively was 8.9±1.7.The average JOA score at 3 months postoperatively was 13.1±2.0,which was significantly higher than that preoperatively.At 3 months postoperatively,the average improvement rate was 52.0％,and the superior rate was 52.3 ％.At 1 year postoperatively,the average JOA score was 13.3±2.1,which improved significantly from that preoperatively.The average improvement rate was 54.3 ％,and the superior rate was 61.9％.The VAS score at preoperatively was 3.0±2.4,and which was 2.7± 1.7 at 1 year postoperatively with no significant differences.At pre-operation,the level of Frankel classification was C level in one (4.8％) case,D level in 8 (38.1％) cases and E level in 12 (57.1％) cases.At 1 year postoperatively,the level of Frankel classification was C level in one (4.8％) case,D level in 6 (28.6％) cases and E level in 14 (66.7％) cases,compared with that at preoperatively,there was no statistically significant difference.One patients suffered from neurologic deterioration at 1 year after surgery and recovered after anterior cervical surgery.No other serious complications were occurred.Conclusion For the patients with multi-segmental cervical diseases accompanied cervical lordosis loss,effective spinal decompression by cervical posterior laminoplasty was feasible,and a good clinical efficacy was achieved.