Objective:To develop a multi-task artificial intelligence-assisted system for small bowel capsule endoscopy (SBCE) based on various Transformer neural network architectures. The system integrates lesion recognition, cumulative time statistics, and progress bar marking functions to enhance the efficiency and accuracy of endoscopic image interpretation while effectively reducing missed diagnoses. Methods:A dataset comprising 12 annotated categories of images captured by three different brands of capsule endoscopy devices was collected. Transfer learning and fine-tuning were conducted on five pre-trained Transformer models. Performance metrics, including accuracy, sensitivity, specificity, and recognition speed, were evaluated to select the best-performing model. The optimal model was converted from PyTorch to Open Neural Network Exchange (ONNX) format. Using OpenCV and MMCV tools, a multi-task SBCE-assisted reading system was developed. Results:A total of 34,799 images were included in the study. The best-performing model, FocalNet, achieved a weighted average sensitivity of 85.69%, specificity of 98.58%, accuracy of 85.69%, and an AUC of 0.98 across all categories. Its diagnostic accuracy outperformed junior physicians (χ²=17.26, p<0.05) and showed no statistical difference compared to senior physicians (χ²=0.0716, p>0.05). The multi-task AI-assisted reading system, "FocalCE-Master", developed based on FocalNet, achieved a diagnostic speed of 592.40 frames per second, significantly faster than endoscopists. By integrating cumulative time bar charts with progress bar marking functionality, the system enables rapid localization and review of lesions, effectively streamlining the diagnostic workflow of SBCE. Conclusion:The multi-task SBCE-assisted reading system developed using Transformer networks demonstrated rapid and accurate classification of various small bowel lesions. It holds significant potential in enhancing diagnostic efficiency and image review speed for endoscopists. However, the AI system has not yet been validated in prospective clinical trials, and further real-world studies are needed to confirm its clinical applicability.
Background: There are many risk factors related to early death after surgery among patients with acute Stanford type A aortic dissection (ATAAD) that have been analyzed in previous studies, but no evidence-based study has been conducted to confirm these risk factors.Aims: The aims of this study were to investigate risk factors for early death after surgery in patients with ATAAD via systematic review and meta-analysis and assess evidence-based strategies for preventing adverse events.Methods: The protocol for this study was prospectively registered with PROSPERO (CRD 42022332772). The authors systematically searched PubMed, Ovid, Scopus, Web of Science and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from database construction to May 2021. Studies that met the selection criteria were determined by two independent researchers, and the odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported for the risk factors and were pooled using Stata 15.0.Results: A total of 23 studies including 5510 patients met the inclusion criteria, and 10 risk factors were analyzed in this meta-analysis. The preoperative risk factors for early death after surgery in patients with ATAAD were age [(OR: 1.03, 95% CI (1.01, 1.06)], male sex [(OR: 1.43, 95% CI (1.06, 1.92)], shock [(OR: 1.91, 95% CI (1.06, 3.45)], malperfusion [(OR: 3.45, 95% CI (2.24, 5.31)] and cardiac tamponade [(OR: 3.89, 95% CI (1.17, 12.98)]. Conclusion: Patients with ATAAD who have an older age, male sex, shock, malperfusion and cardiac tamponade have a higher risk for early death after surgery. However, more highly homogenous studies are needed to demonstrate these results. Clinical staff should pay more attention to these factors and take individual actions to reduce mortality after surgery in patients with ATAAD.
Objective:To study and discuss the formation mechanism of Rh null blood group in a case from the perspective of genetics, and to study the Rh blood group genes of her family members. Methods:The Rh blood type phenotype of the proband seeking medical treatment at Department of Internal Medicine in Taizhou People’s Hospital was detected by blood type serology. RhCE genotyping as performed by fluorescence PCR. RhD, RhCE and RhAG exon sequencing were performed using Sanger sequencing. And then the Rh null formation mechanism of the proband was analyzed. For comparison, the Rh blood type phenotype of the proband’s sister and son was detected by serology, and RhCE genotyping, RhD, RhCE and RhAG exon sequencing were performed. Results:The genotype of the proband was CcDEe, and the RhAG exon sequencing showed a homozygous frameshift mutation, with the mutation site at Exon5, nucleotide changed as c.732delC, and amino acid change as p.Phe245Serfs*16. The serological results, genotyping, RhAG exon sequencing and mutation location of the sister of the proband were the same as those of the proband; The serological result of her son was CCDee, the genotyping result was CCDee, and the RhAG exon sequencing result was heterozygous frameshift mutation, consistent with the proband.Conclusion:A novel mutation site in the RhAG gene was discovered after analysis. This site causes incomplete expression of RhAG protein in patients, which in turn affects the expression of other Rh antigens on the cell membrane, resulting in a serological result of Rh null.
Objective:To identify hub genes closely associated with bronchopulmonary dysplasia (BPD) and provide a theoretical basis for understanding the pathogenesis of BPD.Methods:High-throughput gene expression datasets (GSE32472, GSE108756, GSE189582) of blood mRNA from BPD children were obtained from GEO database. Weighted gene co-expression network analysis (WGCNA) was employed to identify key modules. GO and KEGG functional enrichment and GSEA analysis were used to understand the biological processes involved in key module genes. Hub genes were derived by intersecting the key module genes from GSE32472 with differentially expressed genes from GSE108756. Receiver operating characteristic (ROC) curve analysis in conjunction with Logistic regression was conducted to determine the three hub genes closely related to BPD. The diagnostic efficiency of these three hub genes was validated in an external dataset GSE189582.Results:The WGCNA analysis showed that there were 370 genes in red module that were most closely related to BPD in GSE32472. GO analysis revealed biological functions related to cytokine-mediated signaling pathways, leukocyte migration and chemotaxis, neutrophil activation, immune receptor activity and so on. GSEA indicated enrichment of pathways related to immune-related secretory granules, tertiary granules, and exocytotic vesicles in the BPD group. KEGG enrichment showed pathways associated with virus-related cytokine-receptor interactions, estrogen signaling, and sugar metabolism. ROC analysis of the intersection of red module genes with 201 differentially expressed genes from GSE108756 identified three hub genes (IL1R2, ADM, FPR2) with good specificity and sensitivity for diagnosing BPD (all AUC > 0.7) . IL1R2, ADM, and FPR2 had odds ratios for BPD diagnosis of 1.70, 2.16, and 2.47, respectively (all P < 0.05) . The Logistic regression model built with these three hub genes achieved an AUC of 0.882 in the GSE189582 dataset. Conclusion:Three hub genes were screened out through the construction of gene co-expression regulatory network, which may be potential biomarkers of BPD gene, laying a theoretical foundation for revealing the pathogenesis of BPD.
Objective:This study aims to compare and analyze the clinical efficacy of early versus late partial weight-bearing in patients undergoing Taylor Spatial Frame (TSF) external fixation for open tibial shaft fracture.Methods:63 patients with open tibial shaft fractures treated with TSF between January 2018 and June 2020 in the Department of Orthopaedics Ward One of Tianjin Hospital were retrospectively studied. Based on the timing of initiating postoperative partial weight-bearing (PWB) , the patients were classified as the early weight-bearing group initiating PWB at 6 weeks postoperative and the late weight-bearing group initiating at 10 weeks postoperative. The limb function was evaluated using Johner and Wruh’s Criteria during the final follow-up. The duration of TSF application, time to full weight-bearing, and occurrence of complications were recorded and compared between the two groups.Results:Both groups achieved fracture union. At the final follow-up, the early weight-bearing group exhibited a good-to-excellent rate of 83.33%, while the late weight-bearing group showed a good-to-excellent rate of 69.7%, suggesting a statistically significant difference between the two groups ( Z=-2.072, P=0.038) . The early weight-bearing group had a shorter duration of TSF application and time to full weight-bearing compared with the late weight-bearing group, indicating statistically significant differences between the two groups (all P<0.05) . Conclusion:Compared with late PWB, early, regular, continuous, and moderate PWB after TSF external fixation in patients with open tibial shaft fracture can promote fracture healing, reduce the duration of external fixation device usage, facilitate rapid functional recovery of the affected limb, thereby exhibiting clinical application value and guiding significance.
Objective:To quantitatively analyze the stratified pulmonary inflammation burden of hospitalized patients with coronavirus disease 2019 (COVID-19) in Guangzhou during the epidemic of Omicron virus strain based on artificial intelligence (AI) , and explore the correlation between imaging phenotype and clinical phenotype.Methods:Retrospective screening of 836 patients hospitalized with COVID-19 from December 2022 to January 2023 at the First Hospital of Guangzhou Medical University. The clinical and chest CT imaging data of 348 cases meeting the inclusion criteria were collected. The CT images were analyzed using an AI chest CT assessment system. 368 COVID-19 patients who were clinically classified as heavy and critical at the time of admission to the First Hospital of Guangzhou Medical University and the Eighth Hospital of Guangzhou Medical University were included within the same period. The matching analysis of clinical phenotype and imaging phenotype was performed based on visual evaluation and AI.Results:The inflammation burden including the total lesions, volume (cm 3) and percentage (%) of ground glass and solid lesions were greater in critically ill patients with COVID-19 than in non-critically ill patients (all P< 0.001) in three dimensions including bilateral, unilateral and lobar lung. Pneumonia scores in the whole lung and in each lobe (except the middle lobe of the right lung) were higher in critically ill patients with COVID-19 than in non-critically ill patients (all P<0.05) , but whole lung volumes did not differ between the two groups ( P>0.05) . There was no difference in inflammation burden between the two subgroups of critical and heavy phenotype ( P>0.05) . Bilateral lung lesion volume, ground glass and solid lesions volume, bilateral lung lesions percentage, pneumonia grading, and whole lung score were greater in ICU patients with COVID-19 than in general ward patients, and whole lung volume was less than the latter (all P<0.05) . Of the 368 patients with a clinical diagnosis of severe COVID-19 at admission, the imaging diagnosis was severe-critical viralpneumonia (VP) in 178 (48%) and light-medium VP in 145 (39%) , respiratory severity caused by an uncertain COVID-19 diagnosis in 9 (3%) and a non-COVID-19 diagnosis in 36 (10%) . Conclusion:AI-based analysis can quantize the lung inflammation burden in multiple dimensions such as lesion volume and proportion, lung volume, and density changes. It provides objective quantitative indicators for clinical phenotyping and stratification of current inpatients with COVID-19, which may help in the determinization whether clinically severe patients are suffering from severe COVID-19, thus providing an imaging basis for accurate diagnosis and treatment of patients with COVID-19.
Objective:To investigate the effects of accelerator mechanical and dose errors on the dose validation pass rate of the glioma Volumetric Modulated Arc Therapy (VMAT) plan.Methods:The VMAT plan of 20 cases of high-grade glioma was selected and verified with Elekta linear accelerator and PTW intensity modulation verification tool, and the passing rate was counted. Use software Matlab to modify some parameters of these VMAT plans to simulate mechanical and dose errors that may occur during accelerator operation, and recalculate the dose. Use the above equipment again to verify the modified VMAT plan, calculate its pass rate, and compare and analyze it with the original plan's pass rate.Result:Both mechanical errors (frame rotation angle, collimator positioning error, multi-leaf collimator (MLC) positioning error of different types) and dose errors (MU) have an impact on the validation pass rate of the glioma VMAT plan. Further research has shown that MLC errors have a more significant impact on the absolute dose validation pass rate than frame rotation angle errors, collimator errors and MU errors.Conclusion:For the glioma VMAT plan, in order to improve the validation pass rate of the program, it is necessary to separately implement stricter quality control on MLC. Futhermore, appropriate pass rate indicators should be used based on the performance of the testing equipment, absolute dose validation should be used as much as possible.
To investigate the changes of serum inflammatory factors in dogs with third degree atrioventricular block, and their correlation with left ventricular function. The study indicate that third degree atrioventricular block will stimulate inflammatory response and result in abnormal left ventricular function. In addition, inflammatory response may be closely related to left ventricular dysfunction.
类器官是一类在体外培养中依赖人多能干细胞（hPSC）或成体干细胞（ASC）的自组织过程形成的微型器官样结构，在发育生物学、药物筛选、疾病建模和个性化医疗等领域显示出巨大潜力。然而，目前类器官大多缺乏功能性的脉管组分及可灌注的血管网络，营养物质和氧气的被动扩散不足，导致其体积小、复杂性及成熟度不足，从而限制了该研究的进一步优化和发展。近年来，干细胞生物学与生物工程的融合为解决类器官的血管化问题提供了可能。本文回顾了hPSC衍生类器官的研究进展，列举了当前工程学及生物学领域中的血管化策略，并对目前血管化类器官所取得的成就作一综述。
当先天或后天因素造成的骨缺损超出自愈范围时，需通过植骨填充缺损以促进骨修复。目前临床应用的骨修复材料包括自体骨、同种异体骨及各类人工材料，这些材料各有利弊。其中，双相磷酸钙（BCP）因其与天然骨的无机矿化相组成相似，具有较好的生物相容性和生物活性等优点，成为极具前景的骨组织修复材料。许多研究已证明BCP作为仿生骨的潜力。本文将结合近几年关于BCP的研究做一综述总结分析，为临床应用提供一种新思路。
器官移植领域中供体的缺乏是全世界面临的困境，从传统的静态低温保存技术到近年来逐步进入临床应用的体外机械灌注技术，不断提高供体器官（如肝脏、肾脏、心脏和肺脏等）的保存和维护成功率，并拓展至其他器官的保护以及联合治疗性目的、特殊紧急场景的应用等。随着该技术应用于器官的获取、接收、分配、转运和移植多个临床环节，多种因素会引入风险或影响最终效果评价。本文从项目整体风险评估的角度，梳理器官机械灌注技术发展的前沿领域以及未来项目开发和临床研究的挑战。来自监管方、研究机构、企业等组成协同网络，将从政府监管决策和项目管理人主导的技术决策层面，推动项目的实施和应用，最终提升我国作为器官移植大国和制造强国的地位。
Objective:To evaluate the pull-out strength on the osteoporotic vertebral body for anterior transpedicular root screw in cervical spine.Methods:9 wet specimens of normal adult osteoporotic cervical spine (C3-C7) were selected, including 5 males and 4 females. The anterior transpedicular root screw (ATPRS) , anterior transpedicular screw (ATPS) or vertebral body screw (VBS) was randomly placed on both sides of each specimen. All was divided into three groups (ATPRS vs ATPS, ATPRS vs VBS and ATPS vs VBS) with three specimens in each group. After all specimens were scanned by thin-layer CT, DICOM format data was imported into Mimics software for 3D reconstruction, then the guidance drill template of ATPS was designed and quickly printed by 3D printer. ATPS was placed under the guidance drill template, ATPRS and VBS were placed by hand. Finally, the specimens were placed on the biomechanical experimental machine, and the pull-out strength of each group of screw was tested.Results:The average maximum pull-out strength of ATPRS was (287.94±76.78) N, ATPS was (462.23±174.35) N, and VBS was (169.20±89.07) N. There was statistical difference between ATPRs and VBS, ATPRS and VBS and ATPS and VBS for pull-out strength (all P<0.05) . Conclusions:The pull-out strength of the ATPRS was better than VBS, which can provide the biomechanical support for clinical application.
Objective:A linear-double-stranded DNA (ldsDNA) based AND-gate strategy was developed to construct nanobody library in mammalian cells.Measures:We employed the ldsDNA-based AND-gate genetic circuit to introduce nanobody library into cultured mammalian cells. The sequence complexity of the complementary determining regions (CDRs) was introduced into the up- and down-stream ldsDNA by PCR amplification, respectively. After input ldsDNAs being co-transfected into HEK293T cells for 48h, RNA was extracted then cDNA was synthesized. PCR was employed to amplify the library nanobody sequences. High-throughput sequencing (HTS) was employed to analyze the library nanobody sequences.Results:We combined the clean merged paired-end reads from three biological repeats and got 4, 173, 356 reads. About 88.18% of the merged reads contain both upstream- and downstream-ldsDNA sequences. The most abundant read length is 264-bp, which corresponds to the intact sequence length. A total of 22, 172 unique nanobody sequences were identified by high-throughput sequencing. Moreover, the library CDR sequences followed the NNK degeneracy.Conclusion:We developed a novel ldsDNA-based AND gate genetic circuit to construct nanobody library in mammalian cells.
To explore the clinical value of serum pentraxin3 (pentraxin3) combined with Sestrin2 in the early diagnosis and prognosis evaluation of neonatal acute respiratory distress syndrome (ARDS) . The changes of serum pentraxin3 and Sestin2 levels in 126 newborns with ARDS were analyzed, and the value of serum pentraxin3 and Sestin2 in the early diagnosis and prognosis of neonatal ARDS was evaluated. The serum level of Sestin2 in the neonates of ARDS group was lower than that of the control group, and the serum level of pentraxin3 was higher than that of the control group. There were differences in serum pentraxin3 and Sestin2 in children with ARDS with different severity and prognosis. Serum pentraxin3 and Sestin2 are risk factors for poor prognosis of newborn infants with ARDS. The increase of serum pentraxin3 level and the decrease of Sestin2 level in neonatal ARDS are closely related to the severity and prognosis of the disease and have certain clinical value in the early diagnosis and prognosis evaluation of children.
To investigate the differences in options and postoperative complications between minimally invasive and open esophagectomy for patients with esophageal cancer (EC) . Minimally invasive esophagectomy (MIE) has a similar effect with open surgery in lymph nodes dissection, as well as a lower incidence of serous membrane fluid. Clinically, compared with open surgery, MIE was often selectively applied to patients with early EC and upper and middle EC.
Objective:To construct nasopharyngeal carcinoma diagnostic prediction model based on mRNA gene expression through support vector machine recursive feature elimination algorithm and artificial neural network algorithm screening, and to provide a reference for clinical early screening, intervention, and molecular mechanism research.Methods:Gene expression profile data including microarray and RNA-seq data were obtained from public databases [Gene Expression Omnibus (GEO) , International Cancer Genome Consortium (ICGC) , and Genotype Tissue Expression (GTEx) ]comprising 216 nasopharyngeal carcinoma patients and 248 normal controls. Differential expression analysis was first conducted to identify genes associated with nasopharyngeal carcinoma. Key gene features were then selected using support vector machine recursive feature elimination. Finally, an nasopharyngeal carcinoma diagnostic prediction model was constructed using artificial neural network, and its accuracy and predictive performance were assessed through internal and external validation sets.Results:A total of 457 differentially expressed genes were identified. Subsequently, six key gene features, namely PLAU, SHISA3, MMP1, SHANK2, CCDC39, and MEX3A, were selected through support vector machine recursive feature elimination. Based on these features, the diagnostic prediction model constructed using artificial neural network. An area under the curve (AUC) of the receiver operating characteristic curve (ROC) of 0.970 on the training set and 0.907 on the internal validation set were achieved. External validation showed that the AUC of the model on the RNA-seq dataset, microarray dataset, and a combined dataset of both RNA-seq and microarray were 0.851, 0.842, 0.791, respectively.Conclusion:Several potential nasopharyngeal carcinomas diagnostic important genes were identified in this study, and a gene feature-based nasopharyngeal carcinoma diagnostic prediction model was successfully established, which is expected to provide new ideas and references for clinical early screening and treatment intervention as well as molecular mechanism research.
Objective:To investigate the application value of echocardiography (UCG) in risk assessment of cardiovascular adverse events (CAE) in patients with end stage renal diseases (ESRD) .Methods:Patients with ESRD hospitalized in Renmin Hospital of Wuhan University from April 2020 to June 2021 were selected. CAE was considered as the adverse outcome. They were followed up until July 2022 and divided into event group and non-event group according to the occurrence of outcome. The clinical data, blood biochemical parameters and echocardiographic parameters were analyzed by cohort study. Data analysis and drawing were performed in R language (version 4.1.3) . The variables of combined and uncombined echocardiography were screened by Lasso regression, and multivariate Cox regression modeling was included. Random forest was used to analyze the importance of variables, internal resampling method was used and calibration curves were drawn for model validation, and C-index and net reclassification index (NRI) were used to evaluate and compare model efficacy. Kaplan-Meier method was used to draw survival curves and compare the median survival times of different dialysis patients with peak tricuspid regurgitation velocity (TRV) ≥2.5 m/s as assessed by ultrasound.Results:Age, CAE history, serum phosphorus, hemoglobin, left atrial anteroposterior diameter (LAD) , mitral E peak velocity and ratio of mitral to myocardial early velocities (E/e’) , TRV were independently associated with adverse outcomes. Random forest showed that the importance of variables in order of importance were: E/e’, LAD, CAE history, serum phosphorus, hemoglobin, age, TRV. The C-index of unbound and bound ultrasound parameter models were 0.719 (95% CI: 0.690-0.748) and 0.753 (95% CI: 0.726-0.780) , respectively. The calibration curves have good consistency. NRI=0.168 for 1-year events and 0.277 for 2-year events; Kaplan-Meier survival curves showed that the median survival time of TRV≥2.5 m/s group (about 279 days) was lower than that of TRV< 2.5 m/s group (about 619 days) . In the TRV≥2.5 m/s group, the median survival time of peritoneal dialysis (about 316 days) was longer than that of hemodialysis (about 244 days) . Conclusion:E/e’, LAD and TRV are independent predictor of CAE. E/e’ and LAD are important UCG parameters for prognosis of ESRD. TRV can provide valuable information for the selection of dialysis mode. UCG has important clinical application value for risk assessment of CAE in ESRD.
Objective:To investigate the expression of CD3D gene in ovarian cancer tissues, its effect on immune infiltration in ovarian cancer tumor microenvironment and its prognostic value.Methods:GEPIA database was used to analysis the expression of CD3D gene in various tumors including ovarian cancer; 223 cases of ovarian cancer patients and 25 cases of patients with uterine smooth muscle tumor treated in Shanxi Bethune Hospital from January 2011 to December 2017 were collected. 25 patients with total uterus + bilateral adnexa were resected, and the protein expression of CD3D gene was detected in ovarian cancer and normal ovarian tissues by immunohistochemistry SP method, comparing the relationship between the expression of CD3D gene and clinicopathological features of patients with ovarian cancer; the Kaplan Meier plotter database was used to analysis the prognostic value of the CD3D gene; the cBioportal database was used to analysis the co-expressed genes of CD3D gene; DAVID database to analysis the KEGG functional enrichment pathway of CD3D co-expressed genes; TIMER2.0 database to analysis the relationship between CD3D gene expression and immune infiltration of major immune cells in ovarian cancer.Results:CD3D protein was highly expressed in ovarian cancer tissues, with statistically significant differences compared with normal ovarian tissues ( P<0.05) , and there was a significant difference in expression between different FIGO staging periods of ovarian cancer, between whether the residual lesions reached R0 or not ( P<0.05) , and that the high-expression group had a higher survival rate, with a statistically significant difference ( P<0.05) ; Kaplan-Meier-Plotter prognostic analysis also suggested that patients with high CD3D mRNA expression had higher survival rates ( P<0.05) . The enrichment analysis of the expressed genes suggested that the genes in this group were mainly enriched in Th1 and Th2 cell differentiation pathway, T cell receptor signaling pathway, Th17 cell differentiation pathway, primary immunodeficiency pathway, PD-L1 and PD-1 immune checkpoint pathway, natural killer cell-mediated cytotoxicity pathway, etc. The analysis of the Timer database found that the CD3D genes were associated with B cells in the tumor microenvironment, CD8 + T cells, CD4 + T cells and the degree of dendritic cell infiltration in the tumor microenvironment were positively correlated (all P<0.05) . Conclusion:CD3D gene is highly expressed in ovarian cancer tissues, which may affect the invasion of immune cells in the tumor microenvironment by adjusting immune-related pathways and change the prognosis of patients.
