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In the theoretical teaching of valvular heart disease, the traditional teaching method makes the learners feel very abstract and the learning effect is poor. In bedside teaching, the heart characteristics of specific patients cannot be directly displayed to learners, and learners are difficult to construct theoretical knowledge and clinical performance. Based on the clinical bedside internship based on experiential learning theory, this study uses cardiac virtual image technology to reconstruct the cardiac images of clinical patients, restoring the internal structure of their hearts, supplemented by dynamic blood flow images, to make learners can clarify the relationship between cardiac morphology and hemodynamics, so that learners can intuitively learn these knowledge. Through the teaching practice of this study, it is found that high-quality curriculum design and guided teaching combined with the application of new VR technology can significantly improve the learning experience and effect of learners.
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Objective:To investigate the changes in gray matter volume of the subsystems as well as intra-subsystem and inter-subsystem functional connectivity in the default mode network (DMN) of relapsing-remitting multiple sclerosis (RRMS) patients with preserved cognitive function.Methods:In this prospective study, thirty-seven RRMS patients with preserved cognitive function who were admitted to Huashan Hospital of Fudan University from April 2020 to January 2021 (RRMS group) and 43 healthy volunteers (HC group) were recruited. Patients in the RRMS group received the cognitive assessment using a clinical cognitive functioning scale. Three-dimensional T 1WI and resting-state functional MRI were performed to obtain the brain structural and functional data. The DMN was divided into three subsystems: CORE, dorsal medial prefrontal cortex (DMPFC), and medial temporal lobe (MTL). The gray matter volume of the three subsystems were extracted from the gray matter volume map generated by spatial normalization; 24 regions of interest (ROIs) of the DMN were defined based on Yeo′s 17 networks, and their functional connectivity values were calculated to derive the mean intra-subsystem and inter-subsystem functional connectivity values. Differences in gray matter volume and functional connectivity between the RRMS and HC groups were compared using independent sample t-tests; Spearman′s partial correlation was used to analyze the correlation between subsystems′ gray matter volume and functional connectivity, as well as between subsystems′ functional connectivity and clinical scale scores. Results:Compared to the HC group, the gray matter volume of the three subsystems of the DMN were considerably reduced in the RRMS group ( P<0.05). The functional connectivity within and between the three subsystems were not statistically significantly different between the HC and RRMS groups ( P>0.05). Based on the ROI analysis, patients with RRMS the brain regions with significantly reduced DMN intra-subsystem functional connectivity values were mainly located in the left dorsomedial prefrontal cortex of the DMPFC, the right lateral temporal cortex of the DMPFC, and the left medial temporal cortex of the MTL, as compared with the HC group ( P<0.01). The gray matter volume of DMPFC was positively correlated with the functional connectivity within DMPFC in the control group ( r=0.326, P=0.040). In the RRMS group, the gray matter volume of CORE was positively correlated with the functional connectivity between CORE and DMPFC ( r=0.363, P=0.038), and the functional connectivity within CORE was positively correlated with scores on the memory and executive screening scale ( r=0.430, P=0.036). Conclusions:RRMS patients with preserved cognitive function exhibit gray matter atrophy in all three DMN subsystems. There is no correlation between the structure and function of the DMPFC subsystem. The functional connectivity within CORE subsystem may reflect memory and execution status; DMPFC and CORE may be critical encephalic regions for neurodegeneration and brain functional changes in RRMS patients with preserved cognitive function.
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Objective:To investigate the efficacy of a machine learning model based on radiomics of brain lesions on T 2WI in differentiating multiple sclerosis (MS) from neuromyelitis optica spectrum disorders (NMOSD). Methods:Totally 223 MS and NMOSD patients who were treated from January 2009 to September 2018 in Beijing Tiantan Hospital Affiliated to Capital Medical University, Donghu Branch of the First Affiliated Hospital of Nanchang University, Tianjin Medical University General Hospital, and Xuanwu Hospital of Capital Medical University were analyzed retrospectively, and according to the proportion of 7∶3, 223 patients were completely randomly divided into training set (156 cases) and test set (67 cases). A total of 74 patients with MS and NMOSD who were treated in Huashan Hospital Affiliated to Fudan University and China-Japan Friendship Hospital of Jilin University from January 2009 to September 2018 and in Xianghu Branch of the First Affiliated Hospital of Nanchang University from March 2020 to September 2021 were collected as an independent external validation set. All patients underwent brain cross-sectional MR T 2WI, radiomics features were extracted from T 2WI, and features were selected by max-relevance and min-redundancy and least absolute shrinkage and selection operator algorithms. Then various machine learning classifier models (logistic regression, decision tree, AdaBoost, random forest or support vector machine) were constructed to differentiate MS from NMOSD. The area under curve (AUC) of receiver operating characteristics was used to evaluate the performance of each classifier model in the training set, test set and external validation set. Results:Based on multi-center T 2WI, a total of 11 radiomics features related to the discrimination between MS and NMOSD were extracted and classifier models were constructed. Among them, the random forest model had the best efficiency in distinguishing MS from NMOSD, and its AUC values for distinguishing MS from NMOSD in the training set, test set and external validation set were 1.000, 0.944 and 0.902, with specificity of 100%, 76.9% and 86.0%, and sensitivity of 100%, 92.1% and 79.7%, respectively. Conclusion:The random forest model based on the radiomic features of T 2WI of brain lesions can effectively distinguish MS from NMOSD.
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Objective To discuss the clinical effects of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot.Methods From November,2014 to June,2017,16 cases of skin and soft tissue defect in ankle or dorsal foot had been repaired,which were 11 males and 5 females,aged from 25to 58 years old(average,32.5 years).The rotation points were on proximal 5 cm of the lateral malleolus in 11 cases and on the level of tarsal sinus in 5 cases.The largest flap was 10.0 cm×18.0 cm and the smallest flap was 6.0 cm×4.0 cm.The color,thickness,texture,sensation,appearance,donor site shape and functional were followed-up after operation.Results All the 16 patients were followed-up from 1 to 24 months.The distal flap appeared dark in 1 case 2 days after operation,and blood supply was improved after stitches;One case was superficial necrosis and healed after dressing.All the flaps had good appearance and texture,no pigmentation,scar contracture,and so on.Conclusion The forward lateral malleolus perforator flaps have perforator constantly and the color,thickness are similar with the receiving areas,the rotation point could on proximal 5 cm of the lateral malleolus and on the level of tarsal sinus,which is a good method to repair skin and soft tissue defect of ankle or dorsal foot.
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Objective@#To evaluate theresult of Screwless Scarf osteotomy for the treatment of moderate to severe hallux valgus.@*Methods@#From January 2016 to May 2017, 13 patients with 15 feet underwent Screwless (without internal fixation) Scarf osteotomy for the treatment of moderate to severe hallux valgus.The hallux valgus angle (HVA) and intermetatarsal angle(IMA) were compared before and after surgery.Clinical outcomes were assessed by American Orthopedic Foot and Ankle Society (AOFAS) scoring.@*Results@#The mean follow-up was 6 months in all the patients(range, 2-12 months). HVA was decreased by 25.7°(form 38.8°preoperative to 13.1°postoperative). IMA was decreased by 9.6°(form 18.3°preoperative to 8.7°postoperative). AOFAS sore was increase by 39.7 points (45.7 points preoperative to 85.4 points). The incidence of excellence was 86.7%.@*Conclusions@#Satisfactory clinical outcomes can be achieved by screwless Scarf osteotomy for moderate or severe hallux valgus.However, strict indications and sufficient surgical skills are crucial.
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Objective · To evaluate the surgical outcome of RPR composite technique for complex hypertrophic obstructive cardiomyopathy (HOCM). Methods · From June 2009 to December 2015, 9 complex HOCM patients received RPR procedure. There were 6 males and 3 females with age from 22 to 63 years old and the average age of (43±19) years old. Transthorax echocardiography (TTE) showed systolic anterior motion (SAM) and at least moderate mitral valve regurgitation (MR) in all patients before operations. Transesophageal echocardiography (TEE) was used to evaluate the results of procedures during operation. All the patients had been followed up since one week after operation and examined by TTE. Results · All the patients were discharged without complications. Intraoperative TEE indicated that left ventricular outflow tract pressure gradient (LVOTPG) significantly decreased from (92±14) mmHg before operation to (9±3) mmHg after operation (P<0.01). SAM in all the patients disappeared. One week after operation, TTE demonstrated remarkable reduction in the thickness of ventricular septum, LVOTPG and MR than those before operation (P<0.01). Mean follow-up was 26 months. All the patients became asymptomatic. LVOTPG remained low and MR remained mild. There were no deaths, reoperations, or any other adverse consequences. Conclusion · RPR technique is an effective surgical method to relieve LVOTO and MR of complex HOCM to lead a better life.
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Despite the fact that the patency rate of saphenous vein graft(SVG) is less than those of arterial grafts,SVG is fully appreciated by cardiac surgeons and remains the most widely-used conduit for coronary artery bypass grafting(CABG).Recently,thanks to the growing understanding of the pathogenesis of vein graft failure(VGF),the emergence of new drugs and the improvement of surgical techniques,the patency rate of SVG has been well improved.This article reviews the history and the current understanding of SVG,the pathogenesis of VGF,the clinical strategies that may improve the patency rate and the research prospects in this filed.
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BACKGROUND:Thoracolumbar degenerative kyphosis could experience severe lumbar back pain due to sagittal plane imbalance, thereby affecting quality of life. Thus, it is very important to reconstruct spino-pelvic profile in these patients. OBJECTIVE:To explore the relationships between life quality and spino-pelvic parameters fol owing pedicle subtraction osteotomy for thoracolumbar degenerative kyphosis and the clinical significance. METHODS:Between May 2010 and October 2014, 59 patients with thoracolumbar degenerative kyphosis undergoing L2 pedicle subtraction osteotomy in Cangzhou Hospital of Integrated Traditional and Western Medicine were retrospectively reviewed. Anteroposterior and lateral X-ray films of al patients during standing were photographed before and after surgery. The pre-and post-operative thoracic kyphosis, lumbar lordosis, sagittal imbalance, T1 pelvic angle, pelvic incidence, sacral slope and pelvic tilt were measured in al patients. The patients’ quality of life was evaluated using SF-36 preoperatively and postoperatively. RESULTS AND CONCLUSION:(1) Significant differences were observed in the improvement of thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope and sagittal imbalance (P<0.01). With respect to SF-36, postoperative SF-36 score was higher than preoperative postoperative SF-36 score (P<0.01). (2) The alteration of lumbar lordosis showed significant correlation with the change of pelvic tilt, sacral slope and sagittal imbalance. The change of pelvic tilt exhibited cardinal correlation with the change of sacral slope, body pain and general health. The improvement of sagittal imbalance significantly correlated with the improvement of lumbar lordosis, body pain and general health. The improvement of T1 pelvic angle significantly correlated with the improvement of lumbar lordosis, sagittal imbalance, body pain and general health. (3) Pedicle subtraction osteotomy can effectively restore spino-pelvic sagittal profile, improve the life quality and relieve pain for the patients with thoracolumbar degenerative kyphosis.
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Objective To explore the effect of HDAC1 deacetylase inhibition on the proliferation differentiation and invasion in human gastric cancer stem cells (GCSCs) .Methods The GCSCs were selected as CD44 marker by using flow cytometry .RT-qPCR and Western Blot were used to detect the expression of HDAC 1 in GCSCs and non GCSCs .The effect of proliferation and in-vasion in GCSCs were observed by CCK-8 assay ,colony formation and transwell assay after the cells were treated with TSA .The expression of proteins related apoptosis ,differentiation and invasion were detected by using RT-qPCR and Western blot .Results The expression of HDAC1 in GCSCs was higher than that in non GCSCs .The capacities of proliferation and invasion in experimen-tal group were attenuated compared to the control group .The proteins related differentiation was down regulated ,and epithelial mesenchymal transition was mediated .Conclusion After the deacetylation of HDAC1 was inhibited ,the proliferation ,differentia-tion and invasion of GCSCs were reduced .
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BACKGROUND:MicroRNAs (miRNAs) play an important role in many diseases. To analyze the miRNA expression profile in degenerative scoliosis patients is helpful for classifying its pathogenesis. OBJECTIVE: To compare miRNAs expression profile in the intervertebral disc tissue between degenerative scoliosis patients and healthy controls, and to investigate its role in the pathogenesis of degenerative scoliosis. METHODS:Degenerative nucleus pulposus tissues from 48 patients with degenerative scoliosis (male 36, female 12; 58-69 years old) and normal nucleus pulposus tissues from 36 patients with lumbar fractures were harvested to isolate, culture and identify nucleus pulposus cels folowed by total RNA extract. Differentialy expressed miRNAs were screened by microRNA microarray analysis and validated by real-Time qPCR. Target genes of highly expressed microRNAs were predicted by analyzing information from MicroCosm v5, TargetScan 5.1 and microRNA.org databases. Biological signal pathways associated with the target genes were analyzed, and qPCR was used to validate the screening results. RESULTS AND CONCLUSION:Nineteen differentialy expressed miRNAs were identified. The miR-98 was highly expressed in degenerative nucleus pulposus tissue, and the fold change was 6.368. Predicted miR-98 target gene was interleukin-10, which was involved in JAK-STAT signaling pathway and located in upstream of this pathway. In degenerative nucleus pulposus cels of degenerative scoliosis patients, miR-98 was highly expressed, and the corresponding target gene was interleukin-10. These results indicate that JAK-STAT signaling pathway may play an important role in the pathogenesis of degenerative scoliosis.
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[Objective] To study the analgesic, anti-diarrhea and anti-inflammatory effects of Wulian compound extract. [Method] To study the analgesic effect of Wulian compound extract on mice with hot-plate test, writhing test, and formaldehyde stimulation. To study the anti-inflammatory effect of Wulian compound extract by mice ear-swol en induced by xylene and abdominal cavity capil ary Permeability text .To study the anti-diarrhea effect of the Wulian compound extract with the method of diarrhea induced by castor oil and senna. [Results] Wulian compound extract can inhibit the pain caused by high fever, acetic acid and formaldehyde. Inhibit the xylene induced ear swel ing of mice and increase of celiac capil ary permeability induced by acetic acid. At the same time Wulian compound extract can prolong diarrhea latency induced by the senna and castor oil, reduce the frequency of diarrhea. [Conclusion]Compound Wulian extracts have significant antidiarrheal effect, anti-inflammatory, analgesic.
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Objective To investigate the mouse liver blood vessel images using phase contrast X-ray imaging with synchrotron radiation. Methods 6 female C57BL/6 mice were randomly divided into two groups, 3 mice in each group. In one group, livers excised after hgated arteries, veins and common bile duct. In another group, iodine infused via the portal vein and drained from inferior vena cave until all the blood in the portal veins and hepatic veins was displaced. After infusion, arteries, veins and common bile duct were ligated and livers were excised. Results Blood vessel images were clearly produced by diffraction enhanced imaging. This method can discriminate vessels down to about 40 μm in diameter without contrast agent. Using a contrasting agent more details could be produced. In one liver lobe, the entire branch of the portal vein could be clearly produced by one by one phase contrast image from the main axial blood vessels of liver lobe to the nine generation of branching. Conclusions Phase contrast imaging has the advantage of good contrast and high spatial resolution. [Key wnrds] Synchrotron radiation; Phase contrast imaging; Diffraction enhanced imaging; Blood vessel; X-rays
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Objective To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods 15 patients (10 men and 5 women, 41~75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent agioplasty including renal arterial stenosis 89% (n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of flouroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinial and angiographic follow up. Results Technical success (residual stenosis