The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L4, 5 in 36 cases and L5, S1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.
Objective To review the research progress of C terminal propeptide of collagen type II (CTX-II), a osteoarthritis (OA) biomarker. Methods Domestic and international l iterature about CTX-II was reviewed extensively and summarized. Results CTX-II is investigated broadly and has the best performance of all currently available biomarkers. CTX-II is a truly useful biomarker for early diagnosis, prognosis, and measurement of treatment response in OA. Conclusion Single CTX-II may be not sufficient for early diagnosis and prognosis of OA, so a combination of CTX-II and other biomarkers or diagnosis methods is needed.
Objective To summarize the current research progress about influence of patellofemoral osteoarthritis on clinical outcome of unicompartmental knee arthroplasty (UKA). Methods The recent related literature was extensively reviewed and summarized, including pros and cons to regard the patellofemoral osteoarthritis as the contraindication. Results Previous studies regarded patellofemoral osteoarthritis as the contraindication of UKA. Most of current researches show that the damage to the articular cartilage of the patellofemoral joint to the extent of full-thickness cartilage loss has no influence on outcome of UKA. There is no correlation between preoperative anterior knee pain or medial patellofemoral joint degeneration and the clinical outcome. However, lateral subluxation of the patella has an adverse impact on postoperative curative effect. Degeneration of the lateral patellofemoral joint may be a risk factor of the outcome. Conclusion Patellofemoral osteoarthritis should not be the absolute contraindication of UKA. The effect of degeneration of the lateral patellofemoral joint is not clear at present, and still needs further studies in the future.
ObjectiveTo assess the reliability, effectiveness, and the safety of full endoscopic transforaminal decompression (FETD) under local anesthesia guided by the classification of lateral region of the lumbar spinal canal (CLLSC) in treating lumbar spinal stenosis (LSS) in geriatric patients.MethodsThe clinical data of 63 geriatric patients with LSS met the inclusion criteria underwent FETD surgery between June 2015 and July 2017 were retrospectively analyzed. There were 37 males and 26 females, with a median age of 76 years [interquartile range (IQR), 73-80 years], and a median symptomatic duration of 55 months (IQR, 16-120 months). There were 17 cases of grade B and 46 cases of grade C based on the Schizas morphological grading system. CLLSC was used for imaging evaluation for the stenotic condition, and intra-class correlation coefficients (ICC) were used to test intra-observer and inter-observer reliability of CLLSC. The stenotic condition of patients was re-evaluated by the surgeon after operation, and the results were compared with the findings of preoperative CLLSC. The visual analogue scale (VAS) score for low back pain and leg pain recorded before operation, and at 1 day, 3 months, and 6 months after operation, and last follow-up were used to assess the pain relieving; the functional improvement was evaluate by Oswestry disability index (ODI); the modified Macnab criteria were used to self-evaluate the surgical satisfaction.ResultsThe operation were successfully performed for all patients, with a median operation time of 75 minutes (IQR, 65-85 minutes), postoperative hospitalization stay of 48 hours (IQR, 48-72 hours), and the time to ambulation after operation of 24 hours (IQR, 24-24 hours). Sixty-three patients were followed-up and with a median follow-up time of 18 months (IQR, 13-20 months). Based on preoperative CLLSC classification, there were 72 stenotic zones, distributed 16 in zone 1, 6 in zone 2, 3 in zone 3, 2 in zone 4, 7 in zone 5, 34 in zones 1+2, 2 in zones 3+4, and 2 in zones 4+5. Perioperative complications occurred in 4 cases (6.3%), including 2 cases of intraoperative dural sac tear, 1 of preoperative numbness symptom aggravation, and 1 of postoperative urinary retention. VAS score of leg pain and ODI score at each time point after operation were significantly improved compared with those before operation (P<0.05). VAS scores of low back pain showed no significant difference between pre- and post-operation (P>0.05). At last follow-up, based on the modified Macnab criteria, 19 cases were excellent, 37 were good, 6 were fair, and 1 was poor, and the excellent and good rate was 88.9%. The reliability analysis showed that CLLSC had substantial intra-observer reliability in the geriatric population, with an average ICC of 0.78. There was also a substantial inter-observer reliability, with an average ICC of 0.73. While comparing the preoperative CLLSC results with the postoperative CLLSC results, 53 patients (73.6%) were in full agreement, 15 patients (20.8%) were in partial agreement, and 4 patients (5.6%) were not.ConclusionCLLSC has high reliability in the diagnosis of LSS in the geriatric patients. Combined FETD with CLLSC, accurate diagnosis, and minimal invasion can be performed to achieve safe and effective result.
Objective To study the effect of p38MAPK activity on tumor necrosis factor-α （TNF-α） mRNA and intercellular adhesion molecule 1 （ICAM1） mRNA expressions of isolated rabbit liver during early stage of cold preservation and reperfusion period. Methods Based on the cold preservation and reperfusion model of isolated rabbit liver, the animals were divided into inhibition group （n=12） with 3 μmol/L SB202190 (p38MAPK specificity inhibitor) in perfusate and control group （n=12） with no SB202190 in perfusate. Liver tissue samples were harvested at the time points of before resection, end of cold preservation, and different reperfusion period (10, 30, 60 and 120 min). Protein expression and activity of p38MAPK were detected by Western blot and immunoprecipitation respectively, expression of TNF-α mRNA was detected by RT-PCR, and expression of ICAM1 mRNA was detected by in situ hybridization. Results There was no obvious change of expression of p38MAPK protein in liver tissue both in two groups during the total period （P＞0.05）， and there was no statistically significant difference between two groups （P＞0.05）. At time points of end of cold preservation, 10, 30 and 60 min of reperfusion, the activity of p38MAPK in control group was significantly higher than that at the time points of before resection and 120 min of reperfusion (P＜0.01), and was also significantly higher than that in inhibition group at the same time points (P＜0.01). There was no significant difference in activity of p38MAPK among all time points in inhibition group (P＞0.05). The expressions of TNF-α mRNA and ICAM1 mRNA at the time points of before resection, end of cold preservation, and 10 and 30 min of reperfusion were significantly lower than those in 60 and 120 min of reperfusion in both two groups (P＜0.05, P＜0.01); The expressions of TNF-α mRNA and ICAM1 mRNA in inhibition group were significantly lower than those in control group at the time points of 60 and 120 min of reperfusion (P＜0.01). The activity of p38MAPK of liver tissue during cold preservation and reperfusion period was significantly correlated with the level of TNF-α mRNA and level of ICAM1 mRNA expression （r=0.996, P＜0.01； r=0.985, P＜0.01）. Conclusions These results suggest that p38MAPK pathway may regulate the expressions of TNF-α and ICAM1 at the level of transcription and the activation of p38MAPK can up-regulate TNF-α and ICAM1 expressions, which may be one of the important mechanisms to cause ischemia-reperfusion injury of isolated liver during cold preservation and reperfusion period.
Effective medical image enhancement method can not only highlight the interested target and region, but also suppress the background and noise, thus improving the quality of the image and reducing the noise while keeping the original geometric structure, which contributes to easier diagnosis in disease based on the image enhanced. This article carries out research on strengthening methods of subtle structure in medical image nowadays, including images sharpening enhancement, rough sets and fuzzy sets, multi-scale geometrical analysis and differential operator. Finally, some commonly used quantitative evaluation criteria of image detail enhancement are given, and further research directions of fine structure enhancement of medical images are discussed.