Objective To explore the effects and security of traditional Chinese medicine combined with radiofrequency thermocoagulation in the treatment of lumbar disc herniation.Methods A total of 116 cases with lumbar disc herniation were randomly divided into a treatment group and a control group.The control group (56 cases) was treated with radiofrequency thermocoagulation,while the treatment grouP (60 cases)was treated with Chinese medicine on the basis of the control group.Clinical effect was evaluated by VAS score and JOA score standard analysis before therapy,and 24 hours,1 month,3 month and 6 months after the therapy.Results Thee was no significant differences(x2=0.19,P＞0.05)in VAS and JOA score between the two groups before therapy and 24 hours after the therapy.While after 1 months,3 months and 6 months after the therapy,there was significant difference between the two groups (F value of the control grouP was 168.50、97.80、109.10,F value of the treatment group was 286.50、165.34、75.82,P＜0.01).The therapeutic effects comparison between the two group after 6 months therapy:the recovery rate was 76.7％ and 90.0％ in the control group and the treatment group respectively,showing significant differences (x2=4.568,P＜0.05).Conclusion Chinese medicine combined with radiofrequency thermocoagulation was an effective method for cervical disc herniation.

Objective To explore the clinical effects and safety of radiofrequency thermocoagulation combined with ozone injection in the treatment of failed back surgery syndrome (FBSS). Methods A total of 58 patients suffered from FBSS were treated with radiofrequency thermocoagulation and ozone injection from October 2006 to December 2012.The changes of lumbar and leg functions were observed .The evaluation of clinical efficacy was made by visual analogue scale ( VAS) and Oswestry disability index (ODI) at one week, one month, three months, six months, and twelve months postoperatively , respectively. Results The operation was successfully completed in all the 58 patients , without serious complications .All the cases were followed for one year .The ODI was 20.3 ±3.1 at the last follow-up, which was significantly lower than that before operation (79.8 ±2.6, t=96.871, P=0.000).The VAS of back pain was (7.6 ±0.4) points preoperatively and (3.1 ±0.2) points at the last follow-up, which also showed statistical significance (t=45.206, P=0.000).According to the modified MacNab criteria, clinical outcomes showed excellent in 18 cases and good in 23 cases, with an excellent and good rate of operation being 70.7% (41/58). Conclusion Treatment of FBSS by using radiofrequency thermocoagulation and ozone injection is an effective option .

Objective To explore the efficacy of closed reduction with cannlated compression screws for the treatment of elderly paitents with intertrochanteric fracture.Methods From April 2002 to July 2006,guided by a C-arm X-ray system,58 elderly patients with intertrochanteric fracture were treated by closed reduction with cannlated compression screws.Results The mean operation time was 55 minutes(40 to 70 minutes),and the mean blood loss was 35 ml(30 to 40).The patients were discharged from hospital in 3 to 10 days after the operation(mean,6.5 days).All of the 58 patients were cured.According to criteria for evaluating the outcomes of intertrochantenic fracture,28 cases were excellent,25 were good,3 were fair,and 2 were poor.The Rate of excellent and good outcomes was 91.4%(53/58).Conclusion Closed reduction with cannlated compression screws is effective for elderly paitents with intertrochanteric fracture.

Objective: To investigate the proper methods of acupuncture and moxibustion for controlling body weight and their objects. Methods: 274 outpatients were allocated to 3observation groups: obesity, overweight and normal, using standard weight as an index. The obesity group was divided, at a ratio of 1: 1: 3, into 3 groups: fixed prescription, local treatment and treatment based on syndrome differentiation. The syndromes were classified into five types in the syndrome differentiation group. Different protocols of acupuncture and moxibustion plus auricular-plaster therapy were drawn up for treatment. Body mass index (BMI), body fat (F%),body circumferences and subcutaneous fat were evaluated in the patients before and after treatments. Results: There was a difference in the controlling effect of acupuncture on body weight among different populations. The curative effect was better in the obesity and overweight groups than in the normal group; the effective rate was 72.2%, 72.5% and 44.0%, respectively.There was also a difference in curative effect among obesity patients with different types of syndromes. The curative effects on retention of damp-heat in the stomach, stagnation of liver qi and dampness retention due to splenic hypofunction were equal but all better than those on deficiency of splenonephric yang and intemal heat due to yin deficiency. There was also a difference in curative effect among different protocols. The curative effects in the syndrome differentiation-based treatment and fixed prescription groups were equal (77.8%) but all better than that in the local treatment group (53.3%). Conclusion: Acupuncture and moxibustion is an effective way to treat obesity and overweight. Treatment based on syndrome differentiation and fixed prescription on the basis of syndrome differentiation are effective methods.

Objective:To evaluate the accuracy, completeness, and reproducibility of domestic open-source large language models (LLM) in diabetic retinopathy (DR) patient education, and to explore their potential as intelligent virtual assistants for DR patient education.Methods:A total of 41 questions and answers related to the diagnosis and treatment of DR in five categories, namely risk factors, screening and examination, symptoms and staging, diagnosis, treatment and prognosis.All questions were repeated twice as a " new dialogue" in the LLM, and all the answers were recorded.Three senior fundus physicians independently evaluated the answers on a 6-point Likert scale for accuracy and a 3-point Likert scale for completeness and repeatability, and for each answer, the evaluator was asked to make a recommendation between the LLM and the manual answers.Five questions were randomly selected to evaluate the three open source LLM, ERNIE Bot 3.5, Qwen and Kimi chat, and the LLM with the best overall performance was selected for further evaluation in the full question bank.Results:Among the three LLM, Kimi chat had the best overall performance, Kimi chat performed best, with percentages of 6 for accuracy, 3 for completeness, and 3 for repeatability among the 5 questions at 90%, 90%, and 100%, respectively.For all questions answered, the number of words in manual replies was 106 (70, 202), which was significantly lower than 505 (386, 600) in Kimi chat ( Z=-7.866, P<0.001).There was no significant correlation between the number of Kimi chat replies and the accuracy score ( rs=-0.044, P=0.492), but it was positively correlated with the integrity score ( rs=0.239, P<0.001).The interclass correlation coefficient for accuracy and completeness scores were above 0.700 among three evaluators, with the highest agreement for repeatability at 0.853, followed by completeness of the first response at 0.771.The proportion of responses ≥5 points for accuracy was 87.0%(214/246), the proportion ≥2 points for completeness was 98.0%(241/246), and the proportion higher than 70% for repeatability was 78.5%(193/246).Kimi chat excelled in answering basic questions about the disease such as disease definition, staging, frequency of screening, and common risk factors, but performed poorly on questions involving treatment choices that require a doctor's professional judgment.The proportion of evaluators choosing Kimi chat responses as superior was 69.5% (171/246), and the reasons for non-selection included lack of characteristic answers, inclusion of too much irrelevant information, and lack of responses to questions requiring a high degree of medical expertise. Conclusions:Kimi chat answers DR-related diagnostic questions in a detailed and well-organized manner, with a high degree of accuracy, completeness and reproducibility.

Objective:To evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV).Methods:A retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. Results:The number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery ( χ2=8 051.01) and a considerably lower mean hospitalization day ( Z=4 536 844.50), and the differences were statistically significant ( P<0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower ( Z=1 436.94) and unplanned reoperation rate was significantly higher ( χ2=54.10) were significantly lower in the centralized management group, both of which were statistically significant ( P<0.000 1). Conclusion:PPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.

OBJECTIVES: This study aimed to build a surgical navigation system based on mixed reality (MR) and optical positioning technique and evaluate its clinical applicability in craniomaxillofacial trauma bone reconstruction. Me-thods We first integrated the software and hardware platforms of the MR-based surgical navigation system and explored the system workflow. The systematic error, target registration error, and osteotomy application error of the system were then analyzed via 3D printed skull model experiment. The feasibility of the MR-based surgical navigation system in craniomaxillofacial trauma bone reconstruction was verified via zygomatico-maxillary complex (ZMC) reduction experiment of the skull model and preliminary clinical study. RESULTS: The system error of this MR-based surgical navigation system was 1.23 mm±0.52 mm, the target registration error was 2.83 mm±1.18 mm, and the osteotomy application error was 3.13 mm±1.66 mm. Virtual surgical planning and the reduction of the ZMC model were successfully conducted. In addition, with the guidance of the MR-based navigation system, the frontal bone defect was successfully reconstructed, and the clinical outcome was satisfactory. CONCLUSIONS The MR-based surgical navigation system has its advantages in virtual reality fusion effect and dynamic navigation stability. It provides a new method for doctor-patient communications, education, preoperative planning, and intraoperative navigation in craniomaxillofacial surgery.
Humans ; Surgical Navigation Systems ; Augmented Reality ; Plastic Surgery Procedures ; Skull/surgery*