ObjectiveTo investigate the correlation between CT value and Cage subsidence in patients with lumbar degenerative disease treated with stand-alone oblique lumbar interbody fusion (OLIF). MethodsThe clinical data of 35 patients with lumbar degenerative diseases treated with stand-alone OLIF between February 2016 and October 2018 were retrospectively analyzed. There were 15 males and 20 females; the age ranged from 29 to 81 years, with an average of 58.4 years. There were 39 operative segments, including 32 cases of single-segment, 2 cases of double-segment, and 1 case of three-segment. Preoperative lumbar CT was used to measure the CT values of the axial position of L1 vertebral body, the axial and sagittal positions of L1-4 vertebral body, surgical segment, and the axial position of upper and lower vertebral bodies as the bone mineral density index, and the lowest T value was recorded by dual-energy X-ray absorptiometry. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were recorded before operation and at last follow-up. At last follow-up, the lumbar interbody fusion was evaluated by X-ray films of the lumbar spine and dynamic position; the lumbar lateral X-ray film was used to measure the subsidence of the Cage, and the patients were divided into subsidence group and nonsubsidence group. The univariate analysis on age, gender, body mass index, lowest T value, CT value of vertebral body, disease type, and surgical segment was performed to initially screen the influencing factors of Cage subsidence; further the logistic regression for multi-factor analysis was used to screen fusion independent risk factors for Cage subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to analyze the CT value and the lowest T value to predict the Cage subsidence. Spearman correlation analysis was used to determine the correlation between Cage subsidence and clinical results. Results All the 35 patients were followed up 27-58 months, with an average of 38.7 months. At last follow-up, the VAS and ODI scores were significantly decreased when compared with preoperative scores (t=32.850, P=0.000; t=31.731, P=0.000). No recurrent lower extremity radiculopathy occurred and no patient required revision surgery. Twenty-seven cases (77.1%) had no Cage subsidence (nonsubsidence group); 8 cases (22.9%) had at least radiographic evidence of Cage subsidence, the average distance of Cage subsidence was 2.2 mm (range, 1.1-4.2 mm) (subsidence group). At last follow-up, there was 1 case of fusion failure both in the subsidence group and the nonsubsidence group, there was no significant difference in the interbody fusion rate (96.3% vs. 87.5%) between two groups (P=0.410). Univariate analysis showed that the CT value of vertebral body (L1 axial position, L1-4 axial and sagittal positions, surgical segment, and upper and lower vertebral bodies axial positions) and the lowest T value were the influencing factors of Cage subsidence (P<0.05). According to ROC curve analysis, compared with AUC of the lowest T value [0.738, 95%CI (0.540, 0.936)], the AUC of the L1-4 axis CT value was 0.850 [95%CI (0.715, 0.984)], which could more effectively predict Cage subsidence. Multivariate analysis showed that the CT value of L1-4 axis was an independent risk factor for Cage subsidence (P<0.05). Conclusion The CT value measurement of the vertebral body based on lumbar spine CT before stand-alone OLIF can predict the Cage subsidence. Patients with low CT values of the lumbar spine have a higher risk of Cage subsidence. However, the Cage subsidence do not lead to adverse clinical results.
Objective To explore the expression levels and clinical significance of serum long noncoding RNA myocardial infarction associated transcript (lncRNA MIAT) and microRNA-515-5p (miR-515-5p) in elderly patients with chronic obstructive pulmonary disease (COPD) at different periods. Methods From April 2021 to June 2023, 90 elderly patients with acute exacerbation of COPD treated in Huaibei People’s Hospital were selected as a COPD acute exacerbation group, 88 elderly patients with stable COPD as a COPD stable group, and 90 healthy elderly individuals undergoing physical examination as a control group. The white blood cell count (WBC) and serum lncRNA MIAT and miR-515-5p expression levels were detected in all subjects, blood gas analysis and pulmonary function indexes [oxygenation index (PaO2/FiO2), arterial blood carbon dioxide partial pressure (PaCO2), ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), and FEV1 as a percentage of predicted value (FEV1%pred)] were detected in the patients with COPD. The correlation between serum lncRNA MIAT, miR-515-5p and smoking, WBC, blood gas analysis and pulmonary function indexes were analyzed in the elderly patients with acute exacerbation of COPD. The influencing factors of acute exacerbation of COPD, and the value of serum lncRNA MIAT, miR-515-5p in predicting the occurrence of acute exacerbation of COPD were also analyzed. Results The smoking proportion, WBC, serum lncRNA MIAT expression levels of the control group, the COPD stable group and the COPD acute exacerbation group were increased in turn, serum miR-515-5p expression levels were decreased in turn (P<0.05). Compared with the COPD stable group, PaCO2 was significantly increased in the COPD acute exacerbation group, while PaO2/FiO2, FEV1/FVC and FEV1%pred were significantly decreased (P<0.05); serum lncRNA MIAT in the elderly patients with acute exacerbation of COPD was positively correlated with smoking, WBC, PaCO2 (P<0.05), and negatively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p (P<0.05); serum miR-515-5p was negatively correlated with smoking, WBC, PaCO2 (P<0.05), and positively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred (P<0.05). Smoking, WBC, PaCO2, and lncRNA MIAT were risk factors affecting the acute exacerbation of COPD patients, PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p were protective factors affecting the acute exacerbation of elderly COPD patients (P<0.05). The area under the ROC curve (AUC) of serum lncRNA MIAT, miR-515-5p and their combination in predicting acute exacerbation in elderly COPD patients were 0.823, 0.862 and 0.919, respectively, higher than the AUC predicted by serum lncRNA MIAT and miR-515-5p separately (P<0.05). Conclusions Serum lncRNA MIAT expression was high in elderly patients with COPD, and serum miR-515-5p expression was low, and the changes of both were more obvious in patients with acute exacerbation. Both were correlated with blood gas analysis and pulmonary function indexes in patients with acute exacerbation, and have high value in predicting the occurrence of acute exacerbation in elderly patients with COPD.
In order to study the effect of middle ear malformations on energy absorbance, we constructed a mechanical model that can simulate the energy absorbance of the human ear based on our previous human ear finite element model. The validation of this model was confirmed by two sets of experimental data. Based on this model, three common types of middle ear malformations, i.e. incudostapedial joint defect, incus fixation and malleus fixation, and stapes fixation, were simulated by changing the structure and material properties of the corresponding tissue. Then, the effect of these three common types of middle ear malformations on energy absorbance was investigated by comparing the corresponding energy absorbance. The results showed that the incudostapedial joint defect significantly increased the energy absorbance near 1 000 Hz. The incus fixation and malleus fixation dramatically reduced the energy absorbance in the low frequency, which made the energy absorbance less than 10% at frequencies lower than 1 000 Hz. At the same time, the peak of energy absorbance shifted to the higher frequency. These two kinds of middle ear malformations had obvious characteristics in the wideband acoustic immittance test. In contrast, the stapes fixation only reduced the energy absorbance in the low frequency and increased energy absorbance in the middle frequency slightly, which had no obvious characteristic in the wideband acoustic immittance test. These results provide a theoretical reference for the wideband acoustic immittance diagnosis of middle ear malformations in clinic.
Otitis media is one of the common ear diseases, and its accurate diagnosis can prevent the deterioration of conductive hearing loss and avoid the overuse of antibiotics. At present, the diagnosis of otitis media mainly relies on the doctor's visual inspection based on the images fed back by the otoscope equipment. Due to the quality of otoscope equipment pictures and the doctor's diagnosis experience, this subjective examination has a relatively high rate of misdiagnosis. In response to this problem, this paper proposes the use of faster region convolutional neural networks to analyze clinically collected digital otoscope pictures. First, through image data enhancement and preprocessing, the number of samples in the clinical otoscope dataset was expanded. Then, according to the characteristics of the otoscope picture, the convolutional neural network was selected for feature extraction, and the feature pyramid network was added for multi-scale feature extraction to enhance the detection ability. Finally, a faster region convolutional neural network with anchor size optimization and hyperparameter adjustment was used for identification, and the effectiveness of the method was tested through a randomly selected test set. The results showed that the overall recognition accuracy of otoscope pictures in the test samples reached 91.43%. The above studies show that the proposed method effectively improves the accuracy of otoscope picture classification, and is expected to assist clinical diagnosis.
Objective This study was conducted to evaluate and analyze the clinical effect between subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD), especially compare the incidences of delayed gastric emptying (DGE) between them. Methods The documents about SSPPD and PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and WanFang database. The quality of included studies was assessed according to the Cochrane systematic review methods, and statistical analysis of data was performed by using RevMan 5.3 software. Firstly, comparison of incidence of DGE and other effective indexes between SSPPD group and PPPD group was performed by enrolling all included studies, whether met the DGE standards of International Study Group of Pancreatic Surgery (ISGPS) or not, and then comparison of incidence of DGE and clinical DGE was performed by enrolling included studies that met the DGE standards of ISGPS. Results Ten studies were included, with a total of 804 patients, in which, 433 cases underwent SSPPD and 371 cases underwent PPPD. The results of meta-analysis indicated that, in all the included studies, the total incidence of DGE〔OR = 0.33, 95%CI is (0.17, 0.63),P = 0.000 9〕, and the time of nasogastric tube〔MD = –2.65，95%CI is (–4.49, –0.80),P = 0.005〕, and time of stared liquid diet〔MD = –4.13, 95%CI is (–7.35, –0.91),P = 0.01〕 showed significant differences. The total incidence of DGE, the time of nasogastric tube, and time of stared liquid diet were less in SSPPD group. But there was no significant difference between the SSPPD group and PPPD group in operating time, intraoperative blood loss, time of started solid diet, hospital stay, and incidences of reinsertion of nasogastric tube, pancreatic fistula, intra-abdominal abscess, reoperation, wound infection, postoperative hemorrhage, and mortality (P>0.05). In the 8 studies adopted DGE standard of ISGPS, the total incidence of DGE〔OR = 0.31, 95%CI is (0.15, 0.65)，P = 0.002〕 and incidence of clinical DGE 〔OR = 0.13，95%CI is (0.05, 0.40),P = 0.000 3〕showed significant differences. The total incidence of DGE and incidence of clinical DGE were both lower in SSPPD group. Conclusions Compared with PPPD group, SSPPD group was associated with significantly less incidence of DGE. Meanwhile, the time of the nasogastric tube and started liquid diet are shorter than those of SSPPD. And there is no significant difference in the other aspects.
ObjectiveTo investigate the expression of histone deacetylase 2 (HDAC2) in animal model of benign tracheal stenosis, and explore the mechanism of HDAC2 in development of tracheal stenosis.MethodsEighteen rabbits were randomly divided into a blank control group, a model group, and an erythromycin group, with 6 rats in each group. The model group and the erythromycin group underwent tracheostomy, the inner wall of trachea was brushed back and forth with a nylon brush for more than 20 times to induce benign tracheal stenosis. From 7 days before surgery to 9 days after surgery, the model group received gavage with saline, the erythromycin group received gavage with low-dose erythromycin in dose of 15 mg·kg–1·d–1, and the control group did not receive any treatment. On the 10th day after operation, all the rabbits were sacrificed and the trachea was cut to measure the tracheal stenosis. RNA and protein were extracted from the granulation tissue in the stenosis and the relative mRNA expressions of HDAC2, interleukin (IL)-6 and IL-8 in the granulation tissue were detected by real-time fluorescence quantitative PCR. The relative expression of HDAC2 protein was detected by Western blot.ResultsCompared with the blank control group, the tracheal stenosis in the model group was more obvious [(84.60±1.14)% vs.(27.00±6.44)%], the mRNA and protein expressions of HDAC2 were decreased (0.29±0.07 vs. 1.00±0.00, 0.20±0.02 vs. 0.49±0.04), the mRNA expressions of IL-6 and IL-8 were up-regulated (4.22±0.67 vs. 1.00±0.00, 162.72±23.23 vs.1.00±0.00). Compared with the model group, tracheal stenosis in the erythromycin group was relieved [(64.00±12.25)% vs. (84.60±1.14)%], the mRNA and protein expressions of HDAC2 were increased (0.42±0.14 vs. 0.29±0.07, 0.43±0.01 vs. 0.20±0.02), the mRNA expressions of IL-6 and IL-8 were decreased (0.72±0.24 vs. 4.22±0.67, 130.22±7.93 vs. 162.72±23.23). All the differences were statistically significant (all P<0.05). The Pearson correlation coefficient between tracheal stenosis and HDAC2 mRNA relative expression was –0.96 (P<0.05).ConclusionsThe down-regulation of HDAC2 expression in model of benign tracheal stenosis is related to the occurrence and development of tracheal stenosis. The low dose of erythromycin may be used to treat benign tracheal stenosis by up-regulating expression of HDAC2 and thus inhibiting the inflammatory disorder during tracheal injury repair.