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    Research advances of artificial intelligence in the diagnosis and treatment of orthopaedic diseases
    Lin HUANG,Zhen CHE,Ming LI,Yuxi LI,Qing NING
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 37-45.   DOI: 10.6040/j.issn.1671-7554.0.2022.1426
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    Artificial intelligence (AI) is a new technical science, which conducts deep research and development of theories, methods, core technologies, application software and control systems for the simulation, extension and expansion of human brain intelligence. Its professional fields include robotics, image recognition and expert systems, and so on. AI has an important application value in many medical disciplines, especially in orthopedics. It not only improves the working efficiency of imaging doctors and orthopedic surgeons and reduces the workload, but also provides more safe, reliable and powerful clinical technical support for patients, bringing a great promotion to the diagnosis and treatment of orthopedic diseases. This paper reviews the latest research achievements and limitations of AI in orthopedic diseases, aiming to provide literature reference for the deep integration of AI and orthopedics.

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    Computer vision and lumbar degenerative disease
    Shiqing FENG
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 1-6.   DOI: 10.6040/j.issn.1671-7554.0.2022.0902
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    As an important branch of computer science, computer vision has gradually attracted people's attention, benefited by the development of artificial intelligence in recent years. Some classical algorithms have been industrialized in areas such as autonomous driving or security cameras. Medical image analysis is currently considered one of the most likely areas to achieve industrialization and a hotspot in artificial intelligence research. Computer vision research on lumbar degenerative diseases has sprung up with the development of deep learning algorithms lately. We will review the status of computer vision research related to lumbar degenerative disease, which will be helpful for the understanding of the situation and future trend in the topic.

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    Research advances of spine surgery robot
    Fuxin DU,Tichong ZHANG,Qianqian LI,Rui SONG
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 46-56.   DOI: 10.6040/j.issn.1671-7554.0.2023.0018
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    Spine surgery robot has advantages of accurate positioning, stable operation and reduced radiation exposure. With great clinical application value, it has become a hot field of research and application in recent years. This paper classifies spine surgery robot into guided and active operation according to different scenarios, and introduces spine robots developed by domestic and foreign research institutions and companies and their latest achievements, and elaborates and summarizes the key technologies and future development trends.

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    Factors related to decision-making of breast-conserving surgery for female breast cancer
    Yajie ZHOU,Fei WANG,Lixiang YU,Zhigang YU
    Journal of Shandong University (Health Sciences)    2022, 60 (12): 1-6.   DOI: 10.6040/j.issn.1671-7554.0.2022.1143
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    Breast-conserving surgery has become the standard operation for women with early breast cancer. However, the overall rate of the surgery is still low in China, and many patients with indications failed to receive breast-conserving surgery. Factors affecting the decision to receive surgery are complex, involving social and economic factors such as age, family income and education level. In addition, recommendations of doctors, medical services related to radiation therapy, concern of recurrence also have impacts. This article will review related factors influencing the decision-making of breast cancer patients with breast-conserving surgery indications, so as to provide reference for improving the rate of surgery.

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    Progresses and trends of intelligent technologies in orthopedic shock wave therapy
    Yajun LIU,Zhao LANG,Anyi GUO,Wenyong LIU
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 7-13.   DOI: 10.6040/j.issn.1671-7554.0.2022.1331
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    Extracorporeal shock wave therapy (ESWT) is widely adopted in clinical orthopedics for its safe and non-invasive treatment. However, the experience-based subjective decision-making and long-lasting manual operation of physicians in the conventional orthopedic ESWT have limited its further development. As intelligent technologies are rapidly getting into the orthopedic ESWT, this review summarizes the state-of-the-art of research and application of intelligent technologies in orthopedic ESWT from aspects of computer navigation, machine learning and robotics. Computer navigation technologies can intuitively assist physicians to accurately locate the shock wave probe on the anatomical target of patients. The machine learning methods can automatically predict energy parameters in ESWT. Robotic systems have demonstrated their potential advantages in clinical efficacy especially in the dramatical alleviation of the operation intensity of physicians. These intelligent technologies provide comprehensive support for intellectualization of orthopedic ESWT from eye, brain and hand, respectively. This review also concludes the future technical trends from aspects of the ESWT biological mechanism and dose-effect relationship, the treatment protocol planning and usability of machine learning, and the treatment automation and robotic assistance.

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    Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy
    Yanli BAN, Ying Yanli Writing experts: ZHAO, Hua LI, Wei LIU, Fengnian RONG, Shuping ZHAO, Baoxia CUI
    Journal of Shandong University (Health Sciences)    2023, 61 (11): 1-10.   DOI: 10.6040/j.issn.1671-7554.0.2023.0988
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    Cesarean scar pregnancy (CSP) is a special type of ectopic pregnancy in which a pregnancy sac is implanted at the scar of a previous caesarean section. Without appropriate diagnosis or treatment, it can lead to severe morbidity such as life-threatening massive hemorrhage, and uterine rupture, with subsequent effect of fertility, physical and mental health of patients. Although many different treatment options have been described, there is still no consensus on the optimal surgical treatment strategy. In recent years, treatment of CSP based on classification has drawn more and more attention. The practical clinical classification system with optimal surgical strategy for CSP has been widely validated in Shandong Province, which shows good application value and reliable therapeutic effects. Based on this classification system, and combined with clinical experience and the latest clinical research results, the expert consensus of clinical classification system and surgical strategy for CSP is formulated, aiming to standardize the clinical diagnosis and treatment, and to guide clinical work.

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    Progress in the establishment and application of organoids of bladder cancer
    Andong GUO,Sentai DING
    Journal of Shandong University (Health Sciences)    2023, 61 (11): 20-26.   DOI: 10.6040/j.issn.1671-7554.0.2023.0900
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    Bladder cancer is a common disease of the urinary system. Cisplatin-based chemotherapy is the first-line treatment for inoperable and metastatic myometrial invasive bladder cancer. However, due to resistance, a large number of patients fail in chemotherapy, which leads to tumor recurrence and progression. In recent years, organoid models have become a hot spot in the research of pathogenesis, metastasis and drug sensitivity. The successful establishment of bladder cancer organoids is a breakthrough in the clinical treatment of bladder cancer, because organoids and primary tissues have a high degree of genetic and phenotypic consistency, which can help us better understand the genomic changes of bladder cancer, and detect drug sensitivity and resistance. This article aims to review and analyze the construction process, characteristics, advantages and applications of bladder cancer organoids as preclinical models.

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    Research status and development prospect of deep learning in medical imaging
    Bingjie LIN,Meiyun WANG
    Journal of Shandong University (Health Sciences)    2023, 61 (12): 21-29.   DOI: 10.6040/j.issn.1671-7554.0.2023.0774
    Abstract256)   HTML13)    PDF(pc) (1607KB)(170)       Save

    Precision medicine, imaging first; precision imaging, technology first. In recent years, with the rapid development of artificial intelligence, deep learning, as an important branch, has been widely used in many fields such as signal processing, computer vision and natural language processing, etc., among which medical image data segmentation, disease detection and prognosis prediction based on deep learning have become the hot spots of many scholars' research. In this paper, we will briefly outline the current status of deep learning application in the main technical fields of medical imaging, and analyze the challenges and development prospects of its clinical application in medical imaging, aiming to provide reference for the transformation of deep learning algorithms in the clinic.

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    Application of artificial intelligence in the diagnosis and treatment of spinal deformity
    Nan WU,Jianguo ZHANG,Yuanpeng ZHU,Guilin CHEN,Zefu CHEN
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 14-20.   DOI: 10.6040/j.issn.1671-7554.0.2022.0956
    Abstract389)   HTML8)    PDF(pc) (1691KB)(165)       Save

    Spinal deformity is a highly teratogenic and disabling disease, whose age of onset covers the entire life cycle. With the rapid development of computer technology, artificial intelligence has made remarkable progress, and has huge application potential in the diagnosis and treatment of diseases, especially in the screening, diagnosis and treatment, surgical decision-making, intraoperative operations and complication prediction of spinal deformities. In the past few years, a large number of researches have explored in the related fields and proposed plentiful well-working and promising projects and models. This paper will review the latest advances.

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    Research progress in the application of artificial intelligence in myocardial imaging
    Pei NIE,Ximing WANG
    Journal of Shandong University (Health Sciences)    2023, 61 (12): 1-6.   DOI: 10.6040/j.issn.1671-7554.0.2023.0773
    Abstract167)   HTML18)    PDF(pc) (1451KB)(151)       Save

    Recently, artificial intelligence (AI) has shown great potential in myocardial imaging. AI algorithms achieve automatic segmentation and measurement of myocardial images thus optimizing the workflow. The quantitative features which characterized the pathological changes of myocardium were extracted through radiomics and deep learning techniques. These features may facilitate precise diagnosis and outcome prediction of ischemic and non-ischemic cardiomyopathies. In this review, we will introduce the research progress of AI in myocardial imaging from several aspects: AI-assisted image analysis, diagnosis and outcome evaluation of cardiomyopathies. The limitations of AI in myocardial imaging will also be discussed. We hope this review may provide references for further clinical application research of AI in myocardial imaging.

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    Advances in the application of artificial intelligence in coronary computed tomography angiography
    Guyue ZHAO,Jin SHANG,Yang HOU
    Journal of Shandong University (Health Sciences)    2023, 61 (12): 30-35.   DOI: 10.6040/j.issn.1671-7554.0.2023.0795
    Abstract137)   HTML6)    PDF(pc) (1479KB)(147)       Save

    With the increasingly widespread application of artificial intelligence in the field of medical imaging, its application in coronary artery CT angiography has shown great potential, which helps to improve image quality, optimize post-processing processes, assist disease detection, evaluate functional status, analyse prognosis, and other aspects. Meanwhile, there arise some problems, and the full inspection process should be further optimized to enhance its practicality and efficiency. This article reviews the research progress, existing problems, and future development of artificial intelligence in coronary artery CT angiography.

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    Application status and research progress of knee arthroplasty surgical robot
    Hua QIAO,Huiwu LI
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 29-36.   DOI: 10.6040/j.issn.1671-7554.0.2022.1470
    Abstract579)   HTML10)    PDF(pc) (1380KB)(143)       Save

    As a new technology, surgical robots can significantly improve the accuracy, efficiency and safety of knee arthroplasty. However, owing to the wide variety of surgical robots in the market, there is still no comprehensive evaluation of the application status and research progress. This article firstly introduces surgical robots used in the unicondylar knee arthroplasty, patellofemoral arthroplasty, and total knee arthroplasty, then analyzes their advantages and disadvantages, and finally discusses the shortcomings and proposes possible solutions, hoping to provide reference for the future development.

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    Technical procedure of CT-guided intratumoral chemotherapy for lung tumor
    Mingyong HAN,Xiaoli YU,Fangping ZENG,Bing XIE,Lan LU,Jiaquan QU,Bifeng JIANG,Sihan TANG,Jie TAN,Jin LIANG,Longhui ZHONG,Liu WANG,Xuanzhi ZHAO
    Journal of Shandong University (Health Sciences)    2023, 61 (11): 11-19.   DOI: 10.6040/j.issn.1671-7554.0.2023.0981
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    The incidence and mortality rates of lung cancer in China rank the first of all tumors. At present, there are many effective treatment methods, including surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy and other local and systematic treatments. In recent years, intratumoral chemotherapy, which combines the advantages of local therapy and systemic therapy, has gradually become the focus. By using ultrasound, bronchoscope, ultrasonic bronchoscope, endoscopic ultrasonography or CT and other imaging and interventional modalities, chemotherapeutics such as cisplatin, carboplatin, mitomycin, paclitaxel liposomes, fluorouracil in stock or diluted solutions are directly injected into the cancer tissue through the puncture needle. Intratumoral chemotherapy can increase the concentration of chemotherapeutics in the tumor tissue, reduce the systemic toxicity and side effects, and improve the local control rate of cancers. We have carried out clinical application and exploratory research on intratumoral chemotherapy for lung cancer, liver metastasis and bone metastasis, and observed patients' benefits and primary efficacy. This paper will summarize the technical procedure of CT-guided intratumoral chemotherapy.

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    Innovation and challenge of imaging artificial intelligence in medical field
    Ziliang XU,Minwen ZHENG
    Journal of Shandong University (Health Sciences)    2023, 61 (12): 7-12, 20.   DOI: 10.6040/j.issn.1671-7554.0.2023.0705
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    With the development of science and technology, artificial intelligence (AI) has been applied in the medical imaging field gradually. However, the AI still faces many challenges. In this paper, the imaging application progress of AI in medical field will be reviewed from the aspect of tissue segmentation, auxiliary diagnosis of disease and clinical research, respectively, and the problems in them will also be pointed out. Finally, the challenges of imaging AI in medical field will be discussed.

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    Da Vinci robotic resection of esophageal cancer in Qilu Hospital
    Hui TIAN,Wenbo YI,Shuhai LI
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 28-32.   DOI: 10.6040/j.issn.1671-7554.0.2022.0670
    Abstract751)      PDF(pc) (11861KB)(132)       Save

    Da Vinci Surgical System, an advanced robotic platform designed to perform complex surgical operations by minimally invasive methods, is currently the most widely used surgical robot throughout the world. The fourth-generation Da Vinci surgical robot system was put into use in Qilu Hospital of Shandong University on July 20, 2020. Professor Tian Hui, leader of the Department of Thoracic Surgery, successfully completed the first resection of esophageal cancer in Shandong Province using the system, created a world record of the shortest time for completing 100 cases of Da Vinci robot surgeries, and formulated the procedures of Qilu Artificial Intelligence Robotic Surgery. So far, Professor Tian has completed more than 1, 300 Da Vinci robotic surgeries, including more than 100 resections of esophageal cancer. This paper summarizes our clinical experience of the resection of esophageal cancer (McKeown operation) by Da Vinci robot, expecting to provide reference for colleagues in thoracic surgery.

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    Research advances of artificial intelligence-based medical imaging in the screening, diagnosis and prediction of pneumonia
    Xiao LI,Zhiyuan SUN,Longjiang ZHANG
    Journal of Shandong University (Health Sciences)    2023, 61 (12): 13-20.   DOI: 10.6040/j.issn.1671-7554.0.2023.0803
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    Pneumonia has become the third leading cause of death in the world after ischemic heart disease and cerebrovascular disease, and is a major public health problem that seriously threatens human health. Early, rapid and accurate etiological diagnosis and risk prediction are the primary tasks in the diagnosis, treatment and prevention of pneumonia. However, due to the heavy workload of radiologists and overlapping image manifestations of different types of pneumonia, timely, rapid, and accurate diagnosis and prediction is rather challenging. The rapid development of artificial intelligence (AI) in the imaging field offers hope for solving these clinical challenges. This paper reviews the latest research results of AI in the diagnosis of pneumonia, aiming to discuss the latest progress of AI system in the field of screening, diagnosis and prediction of pneumonia, and provide prospects in the field of pneumonia, so as to provide references for promoting reasonable optimization of clinical management of pneumonia patients in China and improving the level of intelligent diagnosis and treatment of pneumonia.

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    Influencing factors of mild cognitive impairment in elderly patients with type 2 diabetes
    YU Shujuan, WANG Meijuan, CHEN Li, CAO Yingjuan LYU Xiaoyan, LIU Xueyan, LIN Peng, YAN Jingzheng
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 108-112.   DOI: 10.6040/j.issn.1671-7554.0.2022.0345
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    Objective To analyze the influencing factors of mild cognitive impairment(MCI)in elderly patients with type 2 diabetes, and to provide reference for the development of targeted intervention measures. Methods A total of 110 elderly patients with type 2 diabetes were selected with convenience sampling method during Nov. and Dec. 2021, and divided into MCI group and non-MCI group. The influencing factors of MCI were analyzed with univariate and multivariate non-conditional Logistic regression. Results Of the 110 patients, 72(65.45%)had MCI. There were statistically significant differences in age, education level, monthly family income, duration of diabetes and blood glucose before bedtime between MCI group and non-MCI group(P<0.05). Multivariate Logistic regression analysis showed that the monthly family income(OR=0.236, 95%CI: 0.096-0.581), duration of diabetes(OR=1.077, 95%CI: 1.005-1.154), and blood glucose before bedtime(OR=1.213, 95%CI: 1.030-1.428)were the influencing factors of MCI(P=0.002, P=0.036, P=0.020). Conclusion The prevalence of MCI in patients with type 2 diabetes is high. Low family monthly income, long course of diabetes and high blood glucose before bedtime may increase the risk of MCI and should arouse attention.
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    Journal of Shandong University (Health Sciences)    2022, 60 (11): 124-126.   DOI: 10.6040/j.issn.1671-7554.0.2022.0289
    Abstract461)      PDF(pc) (2885KB)(88)       Save
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    Robotics/navigation-assisted pedicle screw implantation in spinal deformity correction surgery
    Xinyu LIU,Donglai LI,Wenlong ZHAO,Zheng WANG,Chao LI,Lianlei WANG,Suomao YUAN,Yonghao TIAN
    Journal of Shandong University (Health Sciences)    2023, 61 (3): 21-28.   DOI: 10.6040/j.issn.1671-7554.0.2022.1125
    Abstract343)   HTML6)    PDF(pc) (1351KB)(85)       Save

    Surgical robotics and navigation systems are the results of technological advances that start a new approach for accurate insertion of the pedicle screw in spine surgery. The anatomical complexity of the spinal region and its proximity to many important blood vessels and nerves, spinal deformities such as vertebral body rotation and variation, narrow pedicle, kyphosis and scoliosis place higher demands on the accuracy of spine surgery. Free-hand placement of pedicle screws relies heavily on operators' experience and intraoperative judgment, but does not allow surgeons to monitor the process of insertion. As a result, the misplacement rate is high. The robotic and navigation systems can provide real-time, three-dimensional images during the operation. Thus, they can assist surgeons in adjusting screws promptly, improving the safety and accuracy of the operation and reducing surgical incision and radiation exposure. However, the expensive equipment costs, long learning curve and high radiation exposure for patients cannot be ignored. Despite the lack of research on long-term outcomes and the uncertainty of intraoperative radiation exposure, robotic and navigation systems have influenced the development of spinal deformity correction surgery.

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    Mechanism of acute injury of eosinophil EOL-1 induced by formaldehyde
    LI Na, GUO Zengli, CHI Lingyi, YANG Lizhuo, MA Zhiyong, FU Zhijie
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 54-62.   DOI: 10.6040/j.issn.1671-7554.0.2022.0797
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    Objective To explore the acute injury effect of formaldehyde on human eosinophils(EOL-1)and the mechanism. Methods EOL-1 cells were cultured in vitro. Eol-1 cells treated with formaldehyde for 2 hours at room temperature were set as the 0 mmol, 5 mmol, 10 mmol, 25 mmol and 50 mmol groups. Cells co-treated with DPI, Tiron and NAC and 25 mmol formaldehyde were divided into control group, formaldehyde group, formaldehyde + DPI group, formaldehyde + Trion group, and formaldehyde + NAC group. According to the different concentrations of NAC, the cells were set as the control group, formaldehyde group, formaldehyde + 0.01 mmol NAC group, formaldehyde + 0.1 mmol NAC group, and formaldehyde +1 mmol NAC group. Cell apoptosis and death were detected with propidium iodide(PI)and Hoechst fluorescent staining. The mitochondrial function damage was detected with rhodamine 123(Rho-123)fluorescent labeling method. The expressions of Bax and Bcl-2 were detected with Western blotting. Results The cell death rates of different concentrations of formaldehyde(0, 5, 10, 25, 50 mmol)were(3.313±2.395)%,(8.205±5.719)%,(20.335±5.167)%,(19.387±6.056)%, and(28.043±8.851)%, respectively. Compared with the 0 mmol group, the 5 mmol group had unchanged cell apoptosis and death(P=1.00), but the 10 mmol(P=0.030), 25 mmol(P=0.033)and 50 mmol groups(P=0.001)had significantly increased cell death, with EC50=25 mmol. The cell mortality rates of formaldehyde group, formaldehyde + DPI group, formaldehyde + Trion group and formaldehyde + NAC group were(61.430±9.885)%,(57.907±13.619)%,(55.700±18.487)% and(21.837±6.674)%, respectively. Formaldehyde + DPI group(P=1.00)and formaldehyde + Trion group(P=1.00)had no effect on formaldehyde-induced cell damage, but formaldehyde + NAC group reversed the formaldehyde-induced cell death(P=0.01). Compared with formaldehyde group(52.853±11.338)%, with different concentrations of NAC, the cell mortality was different [formaldehyde + 0.01 mmol NAC(10.620±4.483)%, formaldehyde + 0.1 mmol NAC(6.257±6.265)%, formaldehyde + 1 mmol NAC(4.002±2.50)%], and the reverse effect of formaldehyde on cell death was concentration-dependent. The results of Rho-123 fluorescence labeling showed that compared with the 0 mmol group, the 10 mmol, 25 mmol, and 50 mmol groups had reduced mitochondrial function(P<0.001), while formaldehyde + NAC group reversed the mitochondrial function damage induced by formaldehyde(809.339±163.210 vs 675.552±126.993, P=0.021). Western blotting results showed that, compared with the control group, 25 mmol formaldehyde significantly down-regulated the protein expression of Bcl-2(0.401±0.122, P<0.001)but up-regulated the protein expression of Bax(2.937±1.388, P=0.006); formaldehyde + NAC group significantly reduced the protein expressions of Bax(1.196±0.597, P=0.018)and Bcl-2(0.717±0.246, P=0.018). Conclusion Formaldehyde ≥10 mmol can induce eosinophil EOL-1 damage by inhibiting mitochondrial function and regulating Bcl-2/Bax signal pathway, while antioxidant NAC can reduce the damage and signal pathway of eosinophil EOL-1 caused by formaldehyde.
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    Time distribution and influencing factors of hepatitis B vaccine birth dose in 1,614 newborns of HBsAg positive women, Jinan City
    ZOU Liping, HE Yujing, XIE Yuanzhong, ZHAO Jianyun, XU Chunhua, MA Yongsheng, LI Chuanbin, LIU Xiaoxue, LIU Chong, ZHAO Xiaodong, SUN Hongyun
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 113-120.   DOI: 10.6040/j.issn.1671-7554.0.2022.0357
    Abstract565)      PDF(pc) (2882KB)(64)       Save
    Objective To investigate the time distribution of the birth dose of hepatitis B(HepB)vaccine in newborns of HBsAg-positive mothers in Jinan, and to evaluate possible problems and difficulties of hospitals in implementing the scheme. Methods Descriptive analysis was applied to describe general information and distribution of birth dose of HepB vaccine. Chi-square test and binary Logistic regression were used to analyze influencing factors. Qualitative field interview materials were analyzed and summarized with subject frame method to investigate the status and problems of current implementation practice. Results In 2020, 1,614 HBsAg positive pregnant women were hospitalized and gave birth at hospital. The rate of HepB vaccine birth dose within 24 hours and 12 hours were 98.76% and 78.81%, respectively. Newborns born at 8-11 and 14-16 oclock had the highest timely vaccination rate. Natural birth(OR=2.083), low birth weight(OR=2.793), birth time at night(OR=1.260)and first birth(OR=1.515)were risk factors affecting timely vaccination(all P<0.05). Qualitative interviews found that personnel and training needs increased after stricter time limit was issued. Conclusion The timely vaccination rate of HepB birth dose among infants of HBsAg positive women was high in 2020 in Jinan. Newborns delivered by caesarean section, with non-low birth weight, non-first-born and born before the peak time of obstetrical vaccination are more likely to be vaccinated in time. Personnel and training needs are the main concerns after stricter time limit is issued. It is suggested to strengthen the training of medical personnel and arrange the vaccination shifts reasonably in order to improve the timely vaccination rate.
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    Prostate clear cell adenocarcinomas: a report of 3 cases and literature review
    ZHU Yongcun, ZHAO Xiushi, SUN Nannan, YAO Zhigang, ZHOU Xingchen, MU Kun
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 102-107.   DOI: 10.6040/j.issn.1671-7554.0.2022.0322
    Abstract362)      PDF(pc) (15203KB)(64)       Save
    Objective To explore the clinicopathological features and differential diagnosis of primary clear cell adenocarcinoma(CCA)of the prostate. Methods The pathological data of 3 cases of primary prostate CCA were retrospectively analyzed and relevant literature was reviewed. Immunohistochemistry(IHC)was performed with a group of differential antibodies. Results The patients aged 29 to 54 years. The CCA was located in prostatic utricle in 2 cases and in prostatic parenchyma in 1 case. The clinical manifestation was hematospermia in 2 cases and progressive dysuria in 1 case. Microscopically, a mixture of three histological structures were observed, including glandular, papillary and solid patterns. The so-called hobnail pattern was visible in the glandular and papillary surfaces. Immunohistochemically, CK7, PAX-8, HNF-1β were positive, and AMACR, NapsinA, CA125 were partially positive. During the follow-up of 12 to 15 months, 1 patient was lost, 1 developed metastases of the lung and inguinal lymph nodes, and the other had no recurrence or metastasis. Conclusion The serum CA125 level might be elevated while prostate specific antigen(PSA)level is normal for patients with prostate CCA. Young patients with hemospermia should be altered. The diagnosis relies on histopathological examination and immunohistochemical staining. The prognosis of patients with tumor located in prostatic parenchyma is worse than that located in prostatic utricle.
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    Hepatic epithelioid hemangioendothelioma complicated with hepatitis B cirrhosis: a case report and literature review
    LI Xiangze, WANG Xianming, SONG Gesheng, CUI Jing, SUN Kai, WANG Haochen, WANG Tiancheng, HAN Shaoqi, TIAN Hu
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 89-95.   DOI: 10.6040/j.issn.1671-7554.0.2022.0572
    Abstract437)      PDF(pc) (14023KB)(64)       Save
    Objective To analyze the clinical and imaging characteristics of a patient with hepatic epithelioid hemangioendothelioma misdiagnosed preoperatively as hepatocellular carcinoma complicated with hepatitis B cirrhosis, so as to improve the understanding of this disease, reduce misdiagnosis and guide clinical diagnosis and treatment. Methods The clinical data of the patient were collected and analyzed, relevant case reports were retrieved and literature review was reviewed. Results The patient, a 51-year-old male, was admitted due to “isolated liver space-occupying lesions found in physical examination for more than 3 days”, and no other special abnormalities were obsevred. There were no obvious abnormalities in tumor markers. MRI of liver showed that plain scan was not characteristic. DWI and ADC suggested limited diffusion at the edge of the lesion, and unrestricted diffusion at the central area, suggesting combined necrosis. Enhanced scanning showed similar results, presenting uneven peripheral enhancement, which tended to invade inwards and clear during the delay period. Postoperative pathology confirmed hepatic epithelioid hemangioendothelioma. Conclusion In clinical diagnosis and treatment, the possibility of liver solid space-occupying lesions should be considered when there are no typical manifestations of common diseases such as hepatocellular carcinoma, cholangiocarcinoma and hepatic hemangioma, especially when imaging suggests typical “capsule retraction sign”, “target sign” or “lollipop sign”.
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    Bronchoalveolar lavage fluid cytokine profile contributes to discriminating local inflammation in children with mycoplasma lobar pneumonia
    ZHANG Amin, LI Guosheng, LI Fuhai
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 82-88.   DOI: 10.6040/j.issn.1671-7554.0.2022.0177
    Abstract506)      PDF(pc) (1486KB)(56)       Save
    Objective To explore the relationship between cytokines in bronchoalveolar lavage fluid(BALF)with lobar pneumonia associated with mycoplasma pneumoniae(MP)in children. Methods A total of 80 children with MP lobar pneumonia treated during Sep. and Dec. 2021 were enrolled. The children were divided into two groups according to metagenome second generation sequencing(mNGS): MP group(n=51), and streptococcus pneumoniae(SP)group(n=29). According to fever duration, The MP group was subdivided into fever duration ≤7 d group(n=22)and >7 d group(n=29). According to pleural effusion, the MP group was subdivided into pleural effusion group(n=18)and non-pleural effusion group(n=33). Cytokines in BALF were compared. Results The levels of IL-6/IL-10 and IL-1β/IL-10 in the BALF of MP group were higher than those in the SP group(P=0.027, P=0.015), while the level of IL-17/IL-10 was lower in MP group than that in SP group(P=0.045). The levels of IL-6/IL-10, IL-1β/IL-10, IL-17/IL-10, IL-12p70/IL-10, IL-4/IL-10 in fever during >7 days were higher than those in the fever duration ≤7 days(P=0.007, P=0.008, P=0.009, P=0.02, P=0.01). The level of IL-6/IL-10 in the pleural effusion group was significantly higher than that in the non-pleural effusion group(P=0.005). The area under the curve(AUC)of IL-6/IL-10, IL-1β/IL-10, IL-17/IL-10, IL-12p70/IL-10, and IL-4/IL-10 in the fever duration >7day were 0.721, 0.719, 0.716, 0.691 and 0.712, respectively. The AUC of IL-6/IL-10 in the pleural effusion group was 0.739. Conclusion The levels of IL-6, IL-1β, IL-17 and IL-4 in BALF of MP lobar pneumonia are associated with the local inflammatory response, which can be used as important indicators to evaluate disease progression in children.
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    Journal of Shandong University (Health Sciences)    2022, 60 (11): 130-132.   DOI: 10.6040/j.issn.1671-7554.0.2022.0545
    Abstract334)      PDF(pc) (5774KB)(53)       Save
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    Application of enhanced recovery after surgery in perioperative management of lung cancer
    Shugeng GAO
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 1-10.   DOI: 10.6040/j.issn.1671-7554.0.2022.1100
    Abstract566)   HTML0)    PDF(pc) (2017KB)(51)       Save

    Enhanced recovery after surgery (ERAS), as a comprehensive perioperative management concept, involves multiple disciplines. It is to promote the rapid recovery of patients by optimizing each stage of the perioperative period. With the vigorous development of modern science and technology, ERAS concept has been popularized in the field of thoracic surgery, and ERAS management model with characteristics of thoracic surgery has been improved. This article will summarize the clinical application and research progress of ERAS concept in the field of lung cancer in thoracic surgery in recent years, and review the current perioperative management of lung cancer from aspects of preoperative preparation, intraoperative management and postoperative rehabilitation, aiming to provide reference for clinicians to apply ERAS concept in the diagnosis and treatment of lung cancer.

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    Effects and mechanism of tetramethylpyrazine on monocrotaline induced pulmonary arterial hypertension in rats
    ZENG Yuanyuan, YANG Dongpeng, DONG Zhu, ZHANG Ben, CAO Yiqiu, WANG Xiaowu
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 63-69.   DOI: 10.6040/j.issn.1671-7554.0.2022.0107
    Abstract454)      PDF(pc) (22167KB)(48)       Save
    Objective To investigate the effects and mechanism of tetramethylpyrazine(TMP)on monocrotaline(MCT)induced pulmonary arterial hypertension(PAH)in rats. Methods A total of 36 male SD rats were randomly divided into control, model and TMP groups, with 12 rats in each group. The rats in the model and TMP groups were given intraperitoneal injection of MCT 50 mg/kg on the 1st day to establish PAH model. After 28 days, the TMP group was given tetramethylpyrazine 80 mg/kg by gavage once a day for 4 weeks. At the end of the experiment, the right ventricular systolic pressure(RVSP)was detected and right ventricular hypertrophy index(RVHI)was counted; the pathomorphological changes of lung tissue were observed with hematoxylin-eosin(HE)staining and Masson staining, and the percentage of wall thickness(WT%)and wall area(WA%)were calculated. The structure of lung tissue was observed with a transmission electron microscope. The expressions of Hippo signal pathway related proteins YAP1, WWTR1 and TEAD1 in lung tissue were detected with immunohistochemical staining and Western blotting. Results Compared with the control group, the model group had increased RVSP and RVHI(P<0.001, P<0.001), significantly narrowed lumen of pulmonary arteries, proliferated collagen fibers, and increased protein expressions of YAP1, WWTR1 and TEAD1(P=0.004, P<0.001, P=0.013). Compared with the model group, the TMP group had decreased RVSP and RVHI(P=0.001, P<0.001), improved pulmonary artery remodeling and right ventricular hypertrophy, reduced fibrosis, and decreased protein expressions of YAP1, WWTR1 and TEAD1(P=0.045, P=0.011, P=0.034). Compared with the control group, the TMP group had increased RVSP and RVHI(P=0.045, P=0.045), and increased protein expressions of YAP1, WWTR1 and TEAD1(P=0.080, P=0.013, P=0.468), in which, the difference of WWTR1 protein expression was significant, suggesting that TMP has limited effects. Conclusion TMP has effects on MCT-induced PAH rat model. The underlying mechanism may be related to the inhibition of expressions of Hippo signal pathway related proteins.
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    Journal of Shandong University (Health Sciences)    2022, 60 (11): 127-129.   DOI: 10.6040/j.issn.1671-7554.0.2022.0338
    Abstract376)      PDF(pc) (935KB)(41)       Save
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    Network pharmacologic mechanism of Huangqi Guizhi Wuwu Decoction in treating heart failure
    FAN Xiaoyan, WANG Yuangeng, CHEN Zetao
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 70-81.   DOI: 10.6040/j.issn.1671-7554.0.2022.0911
    Abstract621)      PDF(pc) (14302KB)(38)       Save
    Objective To explore the mechanism of action of Huangqi Guizhi Wuwu Decoction(the Decoction)in the treatment of heart failure by using network pharmacology-molecular docking technique. Methods The drug components of the Decoction were obtained from the TCMSP database, the targets of drug components were obtained from the Uniprot database, the targets of heart failure were obtained from the GeneCard, OMIM, pharmgkb, TTD, DrugBank databases, and the common targets of the Decoction and heart failure were analyzed with R software. Protein-protein interaction(PPI), gene ontology(GO), Kyoto encyclopedia of genes and genomes(KEGG), and molecular docking analyses were performed using R, Cytoscape, Autodock, and pymol softwares. Results A total of 84 targets of the Decoction, 1,430 differential genes of heart failure, and 118 common targets were obtained. Pathway enrichment analysis of common targets showed that they were mainly related to mitogen activated protein kinase(MAPK)and interleukin-17(IL-17). The results of molecular docking showed that the core target of heart failure had good affinity with the main components of the Decoction, which could bind freely and effectively. Conclusion Quercetin, isorhamnetin and formononetin in the Decoction can play a role in the treatment of heart failure through anti-oxidative stress and anti-fibrosis. The Decoction has multi-level, multi-channel and multi-target effects on heart failure.
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    Exploring the clinicopathological features of three cases of gastric cancer in one pedigree during short-term
    MU Yanxi, WANG Wenjie, CHEN Kang, YAO Yalong, LI Jinzhou, WEI Haoqi, LIU Haipeng, HUANG Zeping, CHEN Xiao
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 96-101.   DOI: 10.6040/j.issn.1671-7554.0.2022.0476
    Abstract484)      PDF(pc) (3162KB)(36)       Save
    Objective To summarize the clinical features of familial clustered gastric cancer to provide reference for the prevention and treatment. Methods The clinical data of 3 brothers and sisters from the same family admitted during Dec. 2016 and Jan. 2022 due to gastric cancer were retrospectively collected. The general condition, clinical characteristics, treatment and outcomes were analyzed. All patients were followed up until March 2022. Results Gastric cancer was clustered in this family, including 2 males and 1 female, with an average age of 47 years at the time of onset. The 3 patients had common living and eating habits, which were in line with the diagnosis of familial clustered gastric cancer. After surgery and postoperative chemotherapy, 1 patient was deceased, and the other 2 were regularly followed up. Conclusion The incidence of familial clustered gastric cancer is relatively low. It is rare that all three siblings in the same family have gastric cancer in a short period of time. Therefore, when there are more than 2 people in the family suffering from gastric cancer, familial aggregation of gastric cancer must be alerted.
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    Expert consensus of Ruijin Hospital on the concept of enhanced recovery after surgery in the clinical practice of thoracic surgery
    Dingpei HAN,Yue YAN,Yuqin CAO,Xin SUN,Yanxia HU,Minxian WANG,Yan LUO,Yongmei SHI,Qing XIE,Junbiao HANG,Hecheng LI
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 11-16.   DOI: 10.6040/j.issn.1671-7554.0.2022.0669
    Abstract585)   HTML0)    PDF(pc) (1527KB)(26)       Save

    Since the proposal of enhanced recovery after surgery (EARS) concept in 1997, it has been widely used in thoracic surgery and other surgical fields. Through the multidisciplinary collaboration of surgery, anesthesia, nursing, rehabilitation and clinical nutrition, a series of perioperative optimization measures are adopted to reduce the physical and psychological stress of patients, shorten the length of hospital stay, reduce the incidence of complications and accelerate postoperative rehabilitation. Based on the consensus of multidisciplinary experts, this article summarizes the clinical practice carried out under the concept of ERAS in the Department of Thoracic Surgery of Ruijin Hospital for the reference of other medical staff.

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    Journal of Shandong University (Health Sciences)    2022, 60 (11): 121-123.   DOI: 10.6040/j.issn.1671-7554.0.2022.0307
    Abstract446)      PDF(pc) (5253KB)(22)       Save
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    Comparison of 34 cases of thoracoscopic wedge resection and 21 cases of segmental resection for stage ⅠA1 non-small cell lung cancer in area P
    Huining LIU,Jun PENG,Yingchun REN,Guang YANG,Wenhao WANG,Jinfeng LIU,Qing TIAN
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 38-43.   DOI: 10.6040/j.issn.1671-7554.0.2022.0606
    Abstract430)   HTML0)    PDF(pc) (1277KB)(20)       Save

    Objective: To investigate the selection of minimally invasive thoracoscopic surgery for stage ⅠA1 non-small cell lung cancer (NSCLC) in area P by dividing the lung segment location of the lesion according to the imaging data, and to compare the prognosis of the two methods. Methods: A retrospective analysis was performed on 55 patients who underwent thoracoscopic wedge resection and segmentectomy, and the patients were divided into wedge resection group (group A, n=34) and segmentectomy group (group B, n=21). Results: In groups A and B, the operation time, postoperative hospital stay, intraoperative bleeding, hospitalization costs, and incidence of postoperative pulmonary air leakage were (18.50±5.55) vs. (61.23±9.83), (3.14±0.95) d vs. (4.95±1.39) d, (12.67±6.54) mL vs. (103.71±16.99) mL, (35, 900±5, 000) yuan vs. (61, 900±10, 200) yuan, 5.88% (2 cases) vs. 28.57% (6 cases), respectively, with statistically significant differences (all P < 0.05). Univariate Logistic regression analysis showed a significant correlation between operation time, postoperative hospital stay, incidence of lung leakage and different operation methods (P < 0.05). Multivariate binary Logistic regression analysis showed that compared with group B, group A had shortened operation time (OR=2.58, 95%CI: 1.71-3.90, P < 0.001), shorter postoperative hospital stay (OR=2.91, 95%CI: 1.01-8.84, P=0.04) and reduced incidence of lung leakage (OR=7.12, 95%CI: 1.13-37.21, P=0.04). Conclusion: For patients with stage ⅠA1 NSCLC, thoracoscopic wedge resection of lung with lesion located in area P has a significant advantage over segmental resection.

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    Optimization of the procedures in minimally invasive esophagectomy: the Qilu practices
    Zhenguo SUN,Hui TIAN
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 33-37.   DOI: 10.6040/j.issn.1671-7554.0.2022.0588
    Abstract503)   HTML0)    PDF(pc) (1494KB)(19)       Save

    Esophageal cancer, as a common malignant cancer with high morbidity and mortality, is mainly treated with surgery. With the development of endoscope technology, minimally invasive esophagectomy (MIE) is taking the place of open esophagectomy. Enhanced recovery after surgery (ERAS) is a new research area in the treatment of esophageal cancer. Guided with the principles of ERAS, our team has optimized the procedures of MIE to ensure that patients undergo the perioperative period smoothly. In this paper, we will summarize these optimized procedures of MIE in order to provide reference for thoracic surgeons.

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    Comprehensive application of anatomical partial lobectomy and enhanced recovery after surgery
    Yue PENG,Lei LIU,Yuan LI,Fenglong BIE,Bolun ZHOU,Runze LI,Ying JI,Guangyu BAI,Fengwei TAN,Yushun GAO,Juwei MU,Qi XUE,Bin QIU,Shugeng GAO
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 44-53.   DOI: 10.6040/j.issn.1671-7554.0.2022.0960
    Abstract580)   HTML0)    PDF(pc) (14422KB)(18)       Save

    Objective: To summarize the application of anatomical partial lobectomy (APL) and enhanced recovery after surgery (ERAS) in order to provide clinical reference and theoretical support for the comprehensive management of minimally invasive surgical treatment of lung cancer. Methods: The clinicopathological and perioperative data of 6, 449 patients who underwent APL during Nov. 1, 2013 and Oct. 31, 2021 were retrospectively collected, including gender, age, smoking history, surgical method, pathology, postoperative hospital stay and other indicators. The period from 2014 to 2018 was regarded as the experience accumulation stage, and the period from 2019 to 2021 the technology maturity stage. The number of surgery, percentage of benign nodules, average postoperative hospital stay, and percentage of postoperative hospital stay over 7 days were compared between the two stages. Results: Of the 6, 449 patients, 2, 094 were males and 4, 355 were females. Among them, 88 bilateral lung surgeries were performed in stages, and 8 bilateral surgeries were performed simultaneously, and altogether 6, 493 APL surgeries were performed. Compared with the experience accumulation stage, in the technology maturity stage, the annual average monthly number of operations increased, the percentage of benign nodules decreased, the average postoperative hospital stay shortened, and the percentage of postoperative hospital stay longer than 7 days decreased (P < 0.05). With the application of ERAS from 2014 to 2021, the average annual postoperative hospital stay for APL gradually decreased from 6.98 days to 3.96 days. The percentage of patients with postoperative hospital stay exceeding 7 days decreased from 23.80% to 2.87%. The results of multivariate Logistic regression analysis showed that gender, age, surgical procedure, and surgical stage were independent risk factors for postoperative hospital stay more than 7 days after APL. Conclusion: ERAS can optimize the perioperative management of APL and accelerate postoperative recovery of patients. APL can be performed on the premise of oncology principles, preserve more healthy lung tissue, minimize the scope of surgical resection and surgical trauma, so that the concept of ERAS can be better applied and promoted in radical surgery for lung cancer.

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    Minimally invasive sleeve lobectomy: opportunities and challenges in the era of immunotherapy
    Huijiang GAO,Yucheng WEI
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 23-27.   DOI: 10.6040/j.issn.1671-7554.0.2022.0978
    Abstract401)   HTML0)    PDF(pc) (1314KB)(14)       Save

    Sleeve lobectomy, as a standard treatment for locally advanced resectable central lung cancer, can maximize the preservation of lung tissue and improve patients' quality of life without affecting survival, compared with total pneumonectomy. With the development of thoracoscopic and robotic technology, minimally invasive sleeve lobectomy has become a routine procedure in thoracic surgery, although bronchial sleeve lobectomy has increased the difficulty of operation. At present, with the development of immunotherapy in the field of neoadjuvant and induction therapy for lung cancer, a growing number of locally advanced resectable or potentially resectable lung cancer has been treated with immunotherapy. This not only improves the prognosis of patients, but also puts forward higher requirements for minimally invasive thoracic surgery, especially minimally invasive sleeve lobectomy. In this paper, the current situation of minimally invasive sleeve lobectomy is systematically described and the prospect is prospected.

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    It is necessary for enhanced recovery after surgery to keep pace with the times
    Guowei CHE
    Journal of Shandong University (Health Sciences)    2022, 60 (11): 17-22.   DOI: 10.6040/j.issn.1671-7554.0.2022.0658
    Abstract665)   HTML0)    PDF(pc) (1363KB)(11)       Save

    The development of minimally invasive surgical techniques and equipment continues to promote the progress of enhanced recovery after surgery (ERAS) and update our understanding. Conversely, the concept and realization of ERAS also need to keep pace with the times. This article illustrates several aspects of ERAS which need to be updated and developed based on the clinical practice in lung surgery, including the goals or objectives of ERAS, team building and thinking about ERAS, management and process optimization of ERAS, and the application of ERAS in promoting tiered diagnosis and treatment or whole-process management.

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