OBJECTIVE: To determine the prevalence of lumbar spondylolysis (LS) and the proportion of spondylolytic spondylolisthesis (SS) in China, and to evaluate the musculoskeletal status of patients with LS and SS. METHODS: Spine Computed Tomography (CT) images were collected from community populations aged 40 and above in a nationwide multi-center project. LS was diagnosed, and SS was graded by an experienced radiologist. Bone mineral density (BMD) and paraspinal muscle parameters were quantified based on CT images. RESULTS: One hundred and seventeen patients of a total of 3,317 individuals were diagnosed with LS, corresponding to a prevalence rate of 3.53%. 63 of the 1,214 males (5.18%) and 54 of the 2,103 females (2.57%) were diagnosed with LS. SS occurred in 64/121 vertebrae (52.89%). BMD was not associated with LS ( P = 0.341). The L5 extensor paraspinal muscle density was higher in the LS group than in the non-LS group. In the LS group, patients with SS had a smaller L5 paraspinal extensor muscle cross-sectional area than those without SS ( P = 0.003). CONCLUSION The prevalence of LS in Chinese adults was 3.53%, with prevalence rates of 5.18% in males and 2.57% in females. Patients with LS have higher muscle density, whereas those with SS have smaller muscle cross-sectional areas at the L5 level.
Humans ; Male ; Female ; Middle Aged ; China/epidemiology* ; Prevalence ; Adult ; Lumbar Vertebrae/diagnostic imaging* ; Spondylolysis/diagnostic imaging* ; Aged ; Bone Density ; Tomography, X-Ray Computed ; Aged, 80 and over ; Spondylolisthesis/epidemiology* ; East Asian People

Objective:To develop a 3D-printed extraocular muscle teaching model and evaluate its teaching effect and learning experience among residents in standardized training.Methods:A total of 24 residents in standardized training who entered the Department of Ophthalmology, Peking Union Medical College Hospital from 2022 to 2024 were included, with 10, 7, and 7 residents in the first, second, and third grades, respectively. A simulated orbit and movable eyeball were constructed based on 3D printing technology. Tractionable elastic silicone bands were arranged on it to simulate healthy extraocular muscles, and non-elastic ropes were used to simulate diseased extraocular muscles. The model was applied in teaching rounds. Before and after the rounds, the residents were tested on basic knowledge (including diagnosis and judgment of surgical indications, with a full score of 40) and core knowledge (including judgment of mainly involved extraocular muscles and surgical design, with a full score of 60). Pearson correlation analysis was used to evaluate the correlation between the residents′ grades and their scores before the rounds, scores after the rounds, and score increments. A questionnaire survey (full score of 100) was conducted to assess their learning experience.Results:Before the teaching rounds, the average basic knowledge score of all residents was (21.0±7.5) and the core knowledge score was (11.3±7.7). These scores were positively correlated with the residents′ grades ( r=0.74, 0.69, all P<0.001) but generally low. After the teaching rounds, the basic knowledge score increased to (31.7±4.6), and the core knowledge score increased significantly to (48.5±3.8). There were no statistically significant differences in these scores among different grades ( P=0.22, P=0.83). The increments of basic knowledge and core knowledge scores decreased with the increase of residents′ grades, with statistically significant correlations ( r=-0.60, -0.65; P=0.002, P=0.001). The average scores of all residents in appearance, convenience, effectiveness, and total score were (18.2±1.1), (26.6±2.2), (40.0±4.0), and (84.8±5.0), respectively. There was no statistically significant correlation between these scores and the residents′ grades ( P=0.24, P=0.84, P=0.25, P=0.58). Suggestions for improving the current teaching model included: increasing the model size for long-distance viewing; enhancing the adhesion between silicone bands (simulating eye muscles) and the simulated eyeball; reducing the friction between the inner sphere and outer shell of the simulated eyeball to improve the model′s maneuverability and flexibility. Conclusions:The 3D-printed extraocular muscle teaching model can help residents of all grades quickly master the key and difficult points in learning restrictive strabismus caused by thyroid-associated ophthalmopathy. In clinical teaching of complex ocular diseases related to systemic diseases, constructing physical teaching models can effectively improve teaching effects and students′ learning experience.

Objective To characterize the features of patent foramen ovale(PFO)-related cryptogenic stroke using diffusion-weighted imaging(DWI)and to investigate the correlation between infarct size and cardiac CT characteristics of PFO.Methods A retrospective,consecutive cohort study was conducted on acute ischemic stroke patients admitted to Neurology Department of Xuanwu Hospital,Capital Medical University from January 2022 to September 2024.Patients were categorized into PFO group,arterio-arterial embolism(AAE)group,and atrial fibrillation(AF)group based on etiological diagnosis.Baseline clinical data,including age,height,body mass index,admission National Institutes of Health stroke scale(NIHSS)score,history of old cerebral infarction,hypertension,diabetes mellitus,coronary heart disease,dyslipidemia,and smoking history were collected and compared.All patients underwent head MR within 24 h of admission.DWI was used to analyze and compare infarct characteristics across the three groups,including lesion number(single or multiple),location(cortical+subcortical,deep white matter,cortical+subcortical+deep white matter,cerebellum+thalamus+brainstem),size(≥15 mm or＜15 mm,based on maximum transverse diameter;for multiple lesions,if any lesion had a maximum diameter≥15 mm,it was categorized as≥15 mm),infarcted vascular territory(anterior,posterior,or both circulations),and specific arterial supply(anterior cerebral artery,middle cerebral artery,posterior cerebral artery,basilar artery,posterior inferior cerebellar artery,superior cerebellar artery,anterior choroidal artery,or multiple arteries).Patients in the PFO group additionally underwent cardiac CT to measure PFO-related parameters:tunnel length,width,height,septum secundum thickness,and fossa ovalis length.Spearman correlation analysis was performed to evaluate the relationship between infarct size and PFO cardiac CT features.Results A total of 232 acute ischemic stroke patients were included(mean age[57±17]years,ranged 19-86 years;141 males,91 females),comprising 116 in the PFO group,36 in the AAE group,and 80 in the AF group.(1)The proportion of males in the PFO group was higher than that in the AF group,it was lower than that in the AAE group.The age,body mass index and proportions of patients with hypertension,diabetes,hyperlipidemia,coronary heart disease were all lower than those in the other two groups(both P＜0.016 7),while other baseline characteristics showed no significant differences(all P＞0.05).(2)The PFO group exhibited a higher proportion of multiple infarcts compared to the AAE group(83.62％[97/116]vs.61.11％[22/36],P＜0.016 7),but a lower proportion than the AF group(83.62％[97/116]vs.98.75％[79/80],P＜0.016 7).The PFO group also showed a significantly higher proportion of cortical+subcortical infarcts(47.41％[55/116]vs.11.11％[4/36]and 6.25％[5/80],respectively,both P＜0.016 7)and infarcts with a maximum diameter＜15 mm compared to both AAE and AF groups(66.38％[77/116]vs.36.11％[13/36]and 11.25％[9/80],respectively,both P＜0.016 7).Furthermore,the PFO group had a lower proportion of anterior circulation infarcts(27.59％[32/116]vs.69.44％[25/36]in AAE group and 67.50％[54/80]in AF group,both P＜0.016 7),but a higher proportion of posterior circulation infarcts(62.07％[72/116]vs.16.67％[6/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).Specifically,middle cerebral artery infarcts were less common in the PFO group(18.97％[22/116]vs.66.67％[24/36]in AAE group and 52.50％[42/80]in AF group,both P＜0.016 7),while posterior cerebral artery infarcts were more common(48.28％[56/116]vs.8.33％[3/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).(3)Spearman correlation analysis revealed that infarct size was negatively correlated with PFO tunnel length(rs=-0.429,P=0.029),fossa ovalis length(rs=-0.408,P=0.038),and septum secundum thickness(rs=-0.525,P=0.006),but not correlated with PFO width or height(both P＞0.05).Conclusions PFO-related cryptogenic stroke is predominantly characterized by multiple small infarcts,primarily located in the cortical+subcortical regions and posterior circulation.Infarct size was found to be negatively correlated with PFO tunnel length,fossa ovalis length,and septum secundum thickness.Comprehensive assessment integrating DWI and cardiac CT features may facilitate the identification of PFO-related stroke.These findings warrant further validation through larger,prospective studies.

Objective To evaluate the value of high-resolution computed tomography(HRCT)signs combined with artificial intelligence(AI)quantitative indexes in differentiating mycoplasma pneumoniae pneumonia(MPP)from bacterial pneumonia(BP)in adults.Methods A total of 100 patients with adult MPP and 100 with adult BP were selected.Univariate and multivariate logistic regression analyses were used to identify independent factors that contribute to the differentiation of these two types of pneumonia.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were employed to evaluate the discrimination ability of the two types of pneumonia.Results A comparison of gender and age between the two groups revealed statistically significant differences(P＜0.05).A comparison of bronchial wall thickening,bud sign,and solid shadows between the two groups yielded statistically significant differences(P＜0.05),while small nodules did not(P＞0.05).AI-based quantification revealed significant differences in distribution of inflammatory foci,consolidation/total lesion ratio,ground-glass opacity(GGO)/total lesion ratio,consolidation density,and GGO density(P＜0.05).Univariate and multivariate logistic regression analyses revealed that left upper lobe(％),left lower lobe(％),right upper lobe(％),right middle lobe(％),and right lower lobe(％)were independent factors that contributed to the identification of the two types of pneumonia.The AUC for HRCT signs alone,AI quantitative indexes alone,and HRCT signs combined with AI quantitative indexes in differentiating the two types of pneumonia were 0.715[95％confidence interval(CI)0.643-0.787],0.822(95％CI 0.764-0.881),and 0.853(95％CI 0.801-0.905),respectively.The utilization of HRCT signs combined with AI quantitative indexes had been demonstrated to possess a substantial capacity to accurately identify two types of pneumonia.Conclusion HRCT signs combined with AI quantitative indexes can improve the accuracy of differentiating MPP from BP in adults.

Objective:To develop a 3D-printed extraocular muscle teaching model and evaluate its teaching effect and learning experience among residents in standardized training.Methods:A total of 24 residents in standardized training who entered the Department of Ophthalmology, Peking Union Medical College Hospital from 2022 to 2024 were included, with 10, 7, and 7 residents in the first, second, and third grades, respectively. A simulated orbit and movable eyeball were constructed based on 3D printing technology. Tractionable elastic silicone bands were arranged on it to simulate healthy extraocular muscles, and non-elastic ropes were used to simulate diseased extraocular muscles. The model was applied in teaching rounds. Before and after the rounds, the residents were tested on basic knowledge (including diagnosis and judgment of surgical indications, with a full score of 40) and core knowledge (including judgment of mainly involved extraocular muscles and surgical design, with a full score of 60). Pearson correlation analysis was used to evaluate the correlation between the residents′ grades and their scores before the rounds, scores after the rounds, and score increments. A questionnaire survey (full score of 100) was conducted to assess their learning experience.Results:Before the teaching rounds, the average basic knowledge score of all residents was (21.0±7.5) and the core knowledge score was (11.3±7.7). These scores were positively correlated with the residents′ grades ( r=0.74, 0.69, all P<0.001) but generally low. After the teaching rounds, the basic knowledge score increased to (31.7±4.6), and the core knowledge score increased significantly to (48.5±3.8). There were no statistically significant differences in these scores among different grades ( P=0.22, P=0.83). The increments of basic knowledge and core knowledge scores decreased with the increase of residents′ grades, with statistically significant correlations ( r=-0.60, -0.65; P=0.002, P=0.001). The average scores of all residents in appearance, convenience, effectiveness, and total score were (18.2±1.1), (26.6±2.2), (40.0±4.0), and (84.8±5.0), respectively. There was no statistically significant correlation between these scores and the residents′ grades ( P=0.24, P=0.84, P=0.25, P=0.58). Suggestions for improving the current teaching model included: increasing the model size for long-distance viewing; enhancing the adhesion between silicone bands (simulating eye muscles) and the simulated eyeball; reducing the friction between the inner sphere and outer shell of the simulated eyeball to improve the model′s maneuverability and flexibility. Conclusions:The 3D-printed extraocular muscle teaching model can help residents of all grades quickly master the key and difficult points in learning restrictive strabismus caused by thyroid-associated ophthalmopathy. In clinical teaching of complex ocular diseases related to systemic diseases, constructing physical teaching models can effectively improve teaching effects and students′ learning experience.

Objective:To systematically summarize the development trajectory and evolving trends of mobile health technologies in the field of type 2 diabetes mellitus (T2DM) both domestically and internationally, providing a reference for future research in this area.Methods:CiteSpace 6.1.R6 software was used to perform a visual analysis of relevant domestic and international literature on T2DM mobile health technologies indexed in China National Knowledge Infrastructure, Wanfang, VIP, and Web of Science core collection. The search period was from 2004 to 2023.Results:A total of 575 Chinese and 771 English articles were included. Overall publication volume showed a steady increase, but global research levels were uneven. High-output countries and institutions were mainly concentrated in developed countries such as the United States, but cooperation was relatively loose. The key categories for both Chinese and English keywords included application population, application type, research tools, influencing factors, and disease management models. The research frontiers both domestically and internationally are "Internet+" and digital health.Conclusions:Mobile health technologies have become an integral part of routine healthcare services for T2DM patients. However, there is still a certain gap between domestic and international research. China should timely focus on the research hotspots and frontiers in this field, actively participate in global collaborations, and improve the depth and breadth of research.

Objective:To systematically summarize the development trajectory and evolving trends of mobile health technologies in the field of type 2 diabetes mellitus (T2DM) both domestically and internationally, providing a reference for future research in this area.Methods:CiteSpace 6.1.R6 software was used to perform a visual analysis of relevant domestic and international literature on T2DM mobile health technologies indexed in China National Knowledge Infrastructure, Wanfang, VIP, and Web of Science core collection. The search period was from 2004 to 2023.Results:A total of 575 Chinese and 771 English articles were included. Overall publication volume showed a steady increase, but global research levels were uneven. High-output countries and institutions were mainly concentrated in developed countries such as the United States, but cooperation was relatively loose. The key categories for both Chinese and English keywords included application population, application type, research tools, influencing factors, and disease management models. The research frontiers both domestically and internationally are "Internet+" and digital health.Conclusions:Mobile health technologies have become an integral part of routine healthcare services for T2DM patients. However, there is still a certain gap between domestic and international research. China should timely focus on the research hotspots and frontiers in this field, actively participate in global collaborations, and improve the depth and breadth of research.

Objective To characterize the features of patent foramen ovale(PFO)-related cryptogenic stroke using diffusion-weighted imaging(DWI)and to investigate the correlation between infarct size and cardiac CT characteristics of PFO.Methods A retrospective,consecutive cohort study was conducted on acute ischemic stroke patients admitted to Neurology Department of Xuanwu Hospital,Capital Medical University from January 2022 to September 2024.Patients were categorized into PFO group,arterio-arterial embolism(AAE)group,and atrial fibrillation(AF)group based on etiological diagnosis.Baseline clinical data,including age,height,body mass index,admission National Institutes of Health stroke scale(NIHSS)score,history of old cerebral infarction,hypertension,diabetes mellitus,coronary heart disease,dyslipidemia,and smoking history were collected and compared.All patients underwent head MR within 24 h of admission.DWI was used to analyze and compare infarct characteristics across the three groups,including lesion number(single or multiple),location(cortical+subcortical,deep white matter,cortical+subcortical+deep white matter,cerebellum+thalamus+brainstem),size(≥15 mm or＜15 mm,based on maximum transverse diameter;for multiple lesions,if any lesion had a maximum diameter≥15 mm,it was categorized as≥15 mm),infarcted vascular territory(anterior,posterior,or both circulations),and specific arterial supply(anterior cerebral artery,middle cerebral artery,posterior cerebral artery,basilar artery,posterior inferior cerebellar artery,superior cerebellar artery,anterior choroidal artery,or multiple arteries).Patients in the PFO group additionally underwent cardiac CT to measure PFO-related parameters:tunnel length,width,height,septum secundum thickness,and fossa ovalis length.Spearman correlation analysis was performed to evaluate the relationship between infarct size and PFO cardiac CT features.Results A total of 232 acute ischemic stroke patients were included(mean age[57±17]years,ranged 19-86 years;141 males,91 females),comprising 116 in the PFO group,36 in the AAE group,and 80 in the AF group.(1)The proportion of males in the PFO group was higher than that in the AF group,it was lower than that in the AAE group.The age,body mass index and proportions of patients with hypertension,diabetes,hyperlipidemia,coronary heart disease were all lower than those in the other two groups(both P＜0.016 7),while other baseline characteristics showed no significant differences(all P＞0.05).(2)The PFO group exhibited a higher proportion of multiple infarcts compared to the AAE group(83.62％[97/116]vs.61.11％[22/36],P＜0.016 7),but a lower proportion than the AF group(83.62％[97/116]vs.98.75％[79/80],P＜0.016 7).The PFO group also showed a significantly higher proportion of cortical+subcortical infarcts(47.41％[55/116]vs.11.11％[4/36]and 6.25％[5/80],respectively,both P＜0.016 7)and infarcts with a maximum diameter＜15 mm compared to both AAE and AF groups(66.38％[77/116]vs.36.11％[13/36]and 11.25％[9/80],respectively,both P＜0.016 7).Furthermore,the PFO group had a lower proportion of anterior circulation infarcts(27.59％[32/116]vs.69.44％[25/36]in AAE group and 67.50％[54/80]in AF group,both P＜0.016 7),but a higher proportion of posterior circulation infarcts(62.07％[72/116]vs.16.67％[6/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).Specifically,middle cerebral artery infarcts were less common in the PFO group(18.97％[22/116]vs.66.67％[24/36]in AAE group and 52.50％[42/80]in AF group,both P＜0.016 7),while posterior cerebral artery infarcts were more common(48.28％[56/116]vs.8.33％[3/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).(3)Spearman correlation analysis revealed that infarct size was negatively correlated with PFO tunnel length(rs=-0.429,P=0.029),fossa ovalis length(rs=-0.408,P=0.038),and septum secundum thickness(rs=-0.525,P=0.006),but not correlated with PFO width or height(both P＞0.05).Conclusions PFO-related cryptogenic stroke is predominantly characterized by multiple small infarcts,primarily located in the cortical+subcortical regions and posterior circulation.Infarct size was found to be negatively correlated with PFO tunnel length,fossa ovalis length,and septum secundum thickness.Comprehensive assessment integrating DWI and cardiac CT features may facilitate the identification of PFO-related stroke.These findings warrant further validation through larger,prospective studies.

Objective To evaluate the value of high-resolution computed tomography(HRCT)signs combined with artificial intelligence(AI)quantitative indexes in differentiating mycoplasma pneumoniae pneumonia(MPP)from bacterial pneumonia(BP)in adults.Methods A total of 100 patients with adult MPP and 100 with adult BP were selected.Univariate and multivariate logistic regression analyses were used to identify independent factors that contribute to the differentiation of these two types of pneumonia.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were employed to evaluate the discrimination ability of the two types of pneumonia.Results A comparison of gender and age between the two groups revealed statistically significant differences(P＜0.05).A comparison of bronchial wall thickening,bud sign,and solid shadows between the two groups yielded statistically significant differences(P＜0.05),while small nodules did not(P＞0.05).AI-based quantification revealed significant differences in distribution of inflammatory foci,consolidation/total lesion ratio,ground-glass opacity(GGO)/total lesion ratio,consolidation density,and GGO density(P＜0.05).Univariate and multivariate logistic regression analyses revealed that left upper lobe(％),left lower lobe(％),right upper lobe(％),right middle lobe(％),and right lower lobe(％)were independent factors that contributed to the identification of the two types of pneumonia.The AUC for HRCT signs alone,AI quantitative indexes alone,and HRCT signs combined with AI quantitative indexes in differentiating the two types of pneumonia were 0.715[95％confidence interval(CI)0.643-0.787],0.822(95％CI 0.764-0.881),and 0.853(95％CI 0.801-0.905),respectively.The utilization of HRCT signs combined with AI quantitative indexes had been demonstrated to possess a substantial capacity to accurately identify two types of pneumonia.Conclusion HRCT signs combined with AI quantitative indexes can improve the accuracy of differentiating MPP from BP in adults.

Objective:To analyze and summarize the clinical manifestations, pathological characteristics, treatment, and outcomes of primary malignant melanoma of the esophagus(PMME)in elderly Chinese patients.Methods:A case study of an elderly patient with PMME was conducted at the Department of Gastroenterology in the China-Japan Friendship Hospital.Additionally, literature and case data on elderly PMME cases reported in China up to July 2023 were gathered and analyzed to summarize the epidemiological characteristics, endoscopic manifestations, clinical presentations, diagnosis, treatment, and prognosis of the disease.Results:A comprehensive review of the literature up to July 2023 documented a total of 114 cases of elderly patients with PMME in China, which also included cases from our hospital.Among these cases, there were 68 male patients(59.6%)and 46 female patients(40.4%), ranging in age from 60 to 81 years, with a median age of 65 years.The predominant clinical manifestations observed were dysphagia and choking while eating, followed by chest pain and retrosternal burning sensation.The majority of the lesions were found in the middle and lower segments of the esophagus, predominantly protruding into the lumen, with only 2 cases(1.8%)displaying esophageal mucosal pigmentation.Immunohistochemical analysis revealed that HMB45 was positive in 74 cases(64.9%)and negative in 3 cases(2.6%), while S-100 was positive in 66 cases(57.9%)and negative in 2 cases(1.8%), although data for some patients were not available.Lymph node or distant metastases were present in 45 cases(39.5%), while 38 patients(33.3%)had tumors confined to the esophagus without metastases.Of the 114 patients, 61(53.5%)had a follow-up period ranging from 0.3 to 39 months, with a median follow-up time of 6.75 months.Among the patients who survived during the follow-up period, there were 30 cases(26.3%), with a follow-up time of 1 to 39 months and a median follow-up time of 7.5 months.For the deceased patients, the time from consultation to death ranged from 0.3 to 31 months.Conclusions:Elderly individuals with PMME in China typically present with a gradual onset, nonspecific symptoms, frequent metastasis upon diagnosis, aggressive behavior, and unfavorable outcomes.