Effects of Jianpi Bushen Formula （健脾补肾方） on the Autophagosomes and PI3K/Akt/mTOR Pathway in Radiation Injured Model Mice / 中医杂志

ObjectiveTo explore the effects and possible mechanisms of Jianpi Bushen Formula （健脾补肾方） on radiation-induced immune function damage of mice. MethodsFifty mice were randomly divided into four groups： normal group， model group， thymosin group， high- and low-dose groups of Jianpi Bushen Formula， with 10 mice in each group. Except for the normal group， the mice in the other groups were irradiated with a single whole-body dose of 6.0 Gy X-rays to establish a radiation-injured mouse model. After the successful modeling， the low- and high-dose groups of the Jianpi Bushen Formula were given respectively 13 g/（kg·d）、 26 g/（kg·d） of the formula by gavage， while the thymosin group was given 11.7 mg/（kg·d） of thymosin by gavage， and the normal group and model group were given 0.1 ml/（10g·d） of 0.9% sodium chloride solution by gavage. Each group was administered once a day for 7 consecutive days. After the last gavage， the mice were weighed， and their spleens were separated and weighed to calculate the spleen index. The levels of interferon gamma （IFN-γ） and interleukin 2 （IL-2） in the spleen tissue were detected by enzyme linked immunosorbent assay （ELISA）. The autophagosomes in the spleen were observed by transmission electron microscopy. The mRNA expression levels of phosphatidylinositol 3-kinase （PI3K）， protein kinase B （Akt）， and mammalian target of rapamycin （mTOR） in the spleen were detected by real-time fluorescent quantitative PCR. The protein expression of PI3K， Akt， and mTOR in the spleen， as well as the expression of autophagy-related proteins microtubule-associated light chain protein 3 （LC3）， Beclin1， and p62 were detected by Western blot. ResultsCompared with the normal group， the model group showed significant decreases in body weight， spleen index， and levels of IFN-γ and IL-2 in the spleen （P＜0.01）； the mRNA and protein expression levels of PI3K， Akt， and mTOR in the spleen were also significantly reduced （P＜0.01）； the expression of Beclin1 protein， the ratio of LC3-II/LC3-I significantly increased （P＜0.01）， while the level of p62 protein expression significantly decreased （P＜0.01）. And transmission electron microscopy showed a significant increase in the number of autophagosomes in the spleen and severe cell structure damage in the model group. Compared with the model group， all the above indicators in each medication group were significantly improved （P＜0.05 or P＜0.01）. In the high-dose Jianpi Bushen Formula group， partial intact cristae were visible in the fine mitochondria of the spleen， and there were more autophagosomes. In the low-dose Jianpi Bushen Formula group and thymosin group， the structure of the fine mitochondria in the spleen was relatively intact， and there were fewer autophagosomes. The improvement effect of the low-dose Jianpi Bushen Formula group was better than that of the high-dose group （P＜0.05 or P＜0.01）， and there was no significant difference between the low-dose group and the thymosin group in terms of each indicator （P＞0.05）. ConclusionJianpi Bushen Formula may alleviate the structural damage of the spleen， promote the recovery of immune function， and achieve a best effect at a low dose by enhancing the PI3K/Akt/mTOR signaling pathway in the spleen and inhibiting the over-activation of autophagy induced by radiation.

Anesthetic strategy for endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion / 国际脑血管病杂志

Endovascular treatment is a standard treatment regimen for patients with acute ischemic stroke caused by large vessel occlusion. The anesthetic strategy for patients with acute ischemic stroke undergoing endovascular treatment includes local anesthesia, conscious sedation, and general anesthesia. However, the optimal anesthetic strategy for patients with acute ischemic stroke undergoing endovascular treatment is controversial.

IgD multiple myeloma: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinical features of IgD multiple myeloma (MM) and the effect and prognosis of daratumumab-based combination therapy.Methods:The clinicopathological data of a IgD MM patient with disease progression and extramedullary infiltration treated with daratumumab in the Affiliated Hospital of Qingdao University in December 2019 were retrospectively analyzed.Results:The 74-year-old woman was diagnosed as IgD MM by bone marrow aspiration and immunofixation electrophoresis. The patient was given VD (bortezomib, dexamethasone), RD (lenalidomide, dexamethasone) and ID (ixazomib, dexamethasone) regimens. In June 2020, the patient developed multiple subcutaneous nodules, and she was assessed as progressive disease with extensive extramedullary infiltration. After treated with daratumumab-PAD (liposomal doxorubicin, bortezomib, dexamethasone) regimen, the patient's subcutaneous nodules were significantly reduced and partially disappeared, and the general condition was significantly improved. But the patient was in a cachexia state and finally died of the irregular treatment and disease progression.Conclusions:IgD MM has a low incidence and a short survival period, and there is no uniform standard treatment. The early application of daratumumab combined with proteasome inhibitors, immunomodulators, cytotoxic drugs and hematopoietic stem cell transplantation may improve the overall survival of patients.

Stratified research on related risk factors of CINⅡ + in CINⅠ patients diagnosed by endocervical curettage under colposcopy / 中华妇产科杂志

Objective:To estimate risks of cervical intraepithelial neoplasia (CIN) Ⅱ or worse (CINⅡ +) on loop electrosurgical excisional procedure (LEEP) specimens with the diagnosis of endocervical curettage (ECC) CINⅠ compared with biopsy CINⅠ, and also to investigate the hierarchical management scheme of ECC CINⅠ based on the relevant factors of CINⅡ + risk. Methods:(1) A retrospective computer-based research for subjects enrolled in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2013 to Jun. 2021 was performed. The case group comprised women with an ECC CINⅠ (ECC results of CINⅠ with colposcopy-directed biopsy results ≤CINⅠ), and the control group comprised women with a biopsy CINⅠ (colposcopy-directed biopsy results of CINⅠ with negative ECC findings) were divided after LEEP surgery and diagnosis in the next three months. The clinical data of all patients before LEEP were analyzed, and the pathological diagnosis between two groups after LEEP was compared. (2) Variables, including age, cytology, high-risk human papillomavirus (HR-HPV), ECC results, cervical transformation zone (TZ) and colposcopy impression, were included to describe the characteristics and compare the incidence of LEEP CINⅡ +. (3) Univariate analysis and Multivariate logistic regression method were used to analyze the related factors that affect the LEEP CINⅡ + in CINⅠ patients. Further, the specific risks caused by related factors and conduct a stratified study in LEEP CINⅡ + were analyzed. Results:(1) Overall, 2 581 women with ECC CINⅠ or biopsy CINⅠ diagnosis who underwent LEEP participated in the study with the mean age (43.6±9.5) years old. Chi square test found that the age and cytology of patients in ECC CINⅠ group were statistically different from those of biopsy CINⅠ group (all P<0.05). There was no significant difference in HR-HPV detection, TZ type and colposcopy impression between the two groups (all P>0.05). ECC CINⅠ comprised 957 women, with LEEP histopathology results revealing 288 (30.1%, 288/957) CINⅡ +, which was significantly higher than that of biopsy CINⅠ which was comprised 1 624 women, with LEEP histopathology results showing 333 (20.5%, 333/1 624) CINⅡ + ( χ2=30.31, P<0.001). (2) Compared by LEEP CINⅡ + with LEEP ≤CINⅠ group, there were no significant difference in the age, HR-HPV, colposcopy impression (all P>0.05); but there were significantly differences in cytology, ECC CINⅠ, type Ⅲ TZ (all P<0.001). Multivariate logistic regression analysis showed that atypical squamous epithelial cells (ASC-H; OR=2.77, 95% CI: 2.04-3.77), high-grade squamous intraepithelial lesions and worse (HSIL +; OR=2.93, 95% CI: 2.24-3.81), ECC CINⅠ ( OR=1.89, 95% CI: 1.56-2.29) and type Ⅲ of TZ ( OR=1.76, 95% CI: 1.45-2.11) were independent risk factors for LEEP CINⅡ + (all P<0.05). (3) When cytology was ≤low-grade squamous intraepithelial lesion (LSIL) and ≥ASC-H, the detection rate of CINⅡ + in ECC CINⅠ was significantly higher than that of biopsy CINⅠ (all P<0.001). In ECC CINⅠ, the rate of CINⅡ + with cytology ≤LSIL was significantly lower than that in cytology ≥ASC-H (56.0% vs 25.9%; χ2=49.38, P<0.001). In type Ⅰ/Ⅱ of TZ, the detection rate of CINⅡ + between ECC CINⅠand biopsy CINⅠ had no significantly different; while in type Ⅲ of TZ, there was significantly different (72.7% vs 46.2%; χ2=4.02, P=0.045). In ECC CINⅠ, type Ⅲof TZ was significantly higher in the rate of CINⅡ + than that of type Ⅰ/Ⅱ of TZ (72.7% vs 21.7%; χ2=16.38, P<0.001). When cytology ≥ASC-H, type Ⅲ of TZ and colposcopy impression of HSIL were combined, the rate of CINⅡ + in ECC CINⅠ was 6/6 while 1/3 in biopsy CINⅠ. Conclusions:Cytology ≥ASC-H, ECC CINⅠ and type Ⅲ TZ are the risk factors of LEEP CINⅡ +. However, cytology ≥ASC-H is more valuable in predicting LEEP CINⅡ + than ECC CINⅠ. For patients with ECC CINⅠ to perform LEEP, it is recommended that cytology ≥ASC-H is taken as the first level stratification, and type Ⅲ TZ is taken as the second level stratification. The colposcopy impression of patients is recommended for a reference parameter.

Intelligent fault diagnosis expert system for multi-parameter monitor based on fault tree / 生物医学工程学杂志

Aiming at the dilemma of expensive and difficult maintenance, lack of technical data and insufficient maintenance force for modern medical equipment, an intelligent fault diagnosis expert system of multi-parameter monitor based on fault tree was proposed in this study. Firstly, the fault tree of multi-parameter monitor was established and analyzed qualitatively and quantitatively, then based on the analysis results of fault tree, the expert system knowledge base and inference engine were constructed and the overall framework of the system was determined, finally the intelligent fault diagnosis expert system for multi-parameter monitor was developed by using the page hypertext preprocessor (PHP) language, with an accuracy rate of 80% in fault diagnosis. The results showed that technology fusion on the basis of fault tree and expert system can effectively realize intelligent fault diagnosis of multi-parameter monitors and provide troubleshooting suggestions, which can not only provide experience accumulation for fault diagnosis of multi-parameter monitors, but also provide a new idea and technical support for fault diagnosis of medical equipment.

Intelligent fault diagnosis of medical equipment based on long short term memory network / 生物医学工程学杂志

In order to solve the current problems in medical equipment maintenance, this study proposed an intelligent fault diagnosis method for medical equipment based on long short term memory network(LSTM). Firstly, in the case of no circuit drawings and unknown circuit board signal direction, the symptom phenomenon and port electrical signal of 7 different fault categories were collected, and the feature coding, normalization, fusion and screening were preprocessed. Then, the intelligent fault diagnosis model was built based on LSTM, and the fused and screened multi-modal features were used to carry out the fault diagnosis classification and identification experiment. The results were compared with those using port electrical signal, symptom phenomenon and the fusion of the two types. In addition, the fault diagnosis algorithm was compared with BP neural network (BPNN), recurrent neural network (RNN) and convolution neural network (CNN). The results show that based on the fused and screened multi-modal features, the average classification accuracy of LSTM algorithm model reaches 0.970 9, which is higher than that of using port electrical signal alone, symptom phenomenon alone or the fusion of the two types. It also has higher accuracy than BPNN, RNN and CNN, which provides a relatively feasible new idea for intelligent fault diagnosis of similar equipment.

Computer-aided intelligent diagnosis and education system for cardiac magnetic resonance imaging / 中华医学教育探索杂志

Cardiac magnetic resonance imaging (CMRI) can comprehensively observe the anatomical structure, motion function and tissue characteristics of the heart through multi-parameter and multi-plane sequence imaging, which has become the gold standard for the diagnosis of cardiomyopathy. However, there is a serious shortage of high-level imaging doctors who can diagnose CMRI due to the numerous sequences and difficult fusion of CMRI. To realize the personalized teaching and interactive education, we have designed a platform that could use artificial intelligence to pre-process medical images for clinical diagnosis, and localize the week points of knowledge, thus improving the teaching effect of cardiac imaging diagnosis.

Advancement of imaging technology for coronary microcirculation dysfunction assessment / 生物医学工程学杂志

Coronary microcirculation dysfunction (CMVD) is an important risk factor for the prognosis of re-perfused ischemic heart. Recent studies showed that the evaluation of CMVD has significant impact on both the early diagnosis of heart diseases relevant to blood supply and prognosis after myocardial reperfusion. In this review, the definition of CMVD from the perspective of pathophysiology was clarified, the principles and features of the state-of-the-art imaging technologies for CMVD assessment were reviewed from the perspective of engineering and the further research direction was promoted.

The research on cardiac volume-time relationship based on retrospective electrocardiograph four-dimension computer tomography data collection and structured sparse algorithm / 生物医学工程学杂志

This paper explores the relationship between the cardiac volume and time, which is applied to control dynamic heart phantom. We selected 50 patients to collect their cardiac computed tomography angiography (CTA) images, which have 20 points in time series CTA images using retrospective electrocardiograph gating, and measure the volume of four chamber in 20-time points with cardiac function analysis software. Then we grouped patients by gender, age, weight, height, heartbeat, and utilize repeated measurement design to conduct statistical analyses. We proposed structured sparse learning to estimate the mathematic expression of cardiac volume variation. The research indicates that all patients' groups are statistically significant in time factor ( = 0.000); there are interactive effects between time and gender groups in left ventricle ( = 8.597, = 0.006) while no interactive effects in other chambers with the remaining groups; and the different weight groups' volume is statistically significant in right ventricle ( = 9.004, = 0.005) while no statistical significance in other chambers with remaining groups. The accuracy of cardiac volume and time relationship utilizing structured sparse learning is close to the least square method, but the former's expression is more concise and more robust. The number of nonzero basic function of the structured sparse model is just 2.2 percent of that of least square model. Hence, the work provides more the accurate and concise expression of the cardiac for cardiac motion simulation.

Study on the expression and signification of TLR4/NO pathway in cervical tumorigenesis with high risk HPV infection / 中华妇产科杂志

Objective To explore the role of toll-like receptor (TLR)/nitric oxide (NO) pathway in cervical tumor with high risk human papillomavirus (hrHPV) infection.Methods (1)Study was based on 36 women with nonmalignantcervical tissue as control group and 36 women with squamous cell cervical cancer (SCC),all with hrHPV infection which were assessed by using 14 types hrHPV E6/E7 mRNA real-time PCR kit.The amount of NO was detected by Griess reaction,the expression of inducible nitric oxide synthase (iNOS) was detected by immunohistochemistry (IHC).The mRNA expression of TLR3,TLR4,TLR7,TLR8,TLR9,nuclear factor-κB (NF-κB) p65 and iNOS in control and SCC epithelium which was captured by laser capture microdissection (LCM) were determined.(2)The expressions of TLR4 in CaSki,HeLa and C33a were detected by cell immunofluorescence method.The mRNA and protein expression of TLR/NO pathway transduction molecules including TLR4,NF-κBp65 and iNOS in CaSki,HeLa and C33a cell lines were detected by real-time PCR and western blot.Results (1)The level of NO was much higher in SCC group than that in control group [(42.92±0.36) μmol/L vs (15.49±0.24) μmol/L;P＜0.05].iNOS was detected in 75％ (27 cases) of patients with squamous cervical carcinoma,while only 6％ (2 cases) of normal controls were confirmed with positve result (P＜0.05).TLR/NO pathway maybe activated in SCC,for the mRNA levels of TLR3,TLR4,TLR7,TLR8,NF-κBp65 and iNOS increased significantly when compared to control group (all P＜0.05),and the greatest change in the expression level of TLR in SCC was spotted on TLR4(7.41±0.39 vs 1.86±0.21).(2)The results of immunofluorescence showed that TLR4 was located at plasma membrance of hrHPV positive HeLa and CaSki cells,while the integral optical density of TLR4 in HeLa cells (3 599±427) or CaSki cells (2 080±456) were higher than that in C33a cells (730±96;P＜0.05).The mRNA and protein level of TLR4,NF-κBp65 and iNOS in HeLa and CaSki cells were higher than those of C33a cells (P＜0.05).Conclusion TLR4/NO pathway is highly expressed in cervical cancer with hrHPV infection,while the pathway may be involved in cervical tumorigenesis with hrHPV infection.

Basal ganglia contributions to visual-spatial working memory / 中华行为医学与脑科学杂志

Objective To explore visual-spatial working memory deficits of patients with basal ganglia damage, based on which tried to provide the new method for detecting the injuries in basal ganglia. Methods Twenty-five patients with lesions in the basal ganglia and twenty-five healthy controls performed visual-spatial working memory tasks, including a face-recognition and a spatial delayed-response. Results For the basal ganglia damage group ,the correct rate of both visual- face ( 54.5 ± 9.6 ) % and visual-spatial ( 80.0 ± 11.7 ) % working memory tasks was significantly lower than that of the control group ( ( 64.3 ± 9.5 ) %, ( 93.6 ± 4.9) %, respectively) ,and the difference was statistically significant ( u= - 147.5,80.5, P＜0. 01 ). For the patients injured in the left basal ganglia, the correct rate of visual- face working memory (48.5 ± 5.4 )% was obviously lower than that of patients injured in the right basal ganglia ( 59.2 ± 9.8 ) %, and the difference was statistically significant ( u =25.5, P＜0. 01 ) ;but the difference of correct rate for the visual-space working memory was not statistically significant( u = 52.5, P＞ 0.05 ). In contrast to the controls, both the visual-face and visual-space working memory of the group with injuries in basal ganglia,had appeared to be disable. Conclusions The results confirmed that patients with lesions in basal ganglia had deficits of visual-spatial working memory,and that injuries either in the left or the right basal ganglia can probably cause the shiftiness of cognitive function. Therefore, the injuries in basal ganglia can be detected by the visual-spatial working memory tests.

The Value of Multi-slice Spiral CT in the Diagnosis of Extrahepatic Cholangicarcioma / 实用放射学杂志

Objective To evaluate the value of MSCT in the diagnosis of extrahepatic cholangiocarcinoma.Methods The MSCT appearances of extrahepatic cholangiocarcinoma confirmed by pathology in 27 cases were analyzed retrospectively.Among them,20 patients underwent plain and four-phase dynamic contrast-enhanced CT scans including early arterial phase,late arterial phase,portal phase and delay phase,7 patients only underwent contrast-enhanced CT scans.Results 15 lesions were located in the hilar and 12 lesions were located in the common bile duct.CT features of cholangiocarcinomas in this group were varied with its position and growth pattern.Besides the direct sign such as delay enhancement,the indirect findings were also specific such as hepatic lobe atrophy,dilated bile duct,etc.Conclusion MSCT is of great value in diagnosis of extrahepatic cholangiocarcinoma.