OBJECTIVE: This study aims to address the configuration and efficiency issues in the use of digital subtraction angiography (DSA) equipment through the practical implementation of a rationalization platform based on the Internet of Things (IoT). METHODS: By employing IoT and data integration technologies, the deep integration of DSA equipment operational data with clinical data was achieved to construct a knowledge base for rational use of DSA equipment. Simultaneously, a knowledge base was developed using software engineering techniques to visually display data analysis results. RESULTS: Through thorough data analysis, an imbalance in DSA usage between the southern and northern hospital campuses was identified. Addressing this issue, optimizations were implemented based on the data analysis results, which ultimately yielded significant effects. These adjustments not only effectively alleviated the pressure on DSA equipment usage in the southern campus, but also increased equipment utilization in the northern district (the average daily working hours have increased from 4.64 h to 7.19 h), shortened patient appointment wait time (the appointment duration in the southern campus decreased by 21.86% year-on-year, while the appointment duration in the northern campus decreased by 20.51% year-on-year). CONCLUSION Through the practical implementation of a DSA rationalization platform based on IoT, this study not only successfully explored methods for rational DSA usage but also provided valuable reference for the rational management of medical equipment.
Internet of Things ; Angiography, Digital Subtraction/instrumentation* ; Humans ; Software

Objective:To investigate the risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures. Methods:A retrospective study was conducted to analyze the 118 patients with thoracolumbar single-segment fracture who had been treated at Department of Orthopaedic Surgery, The First Hospital Affiliated to Soochow University between January 2020 and January 2023. The patients were divided into a case group (47 cases) and a control group (71 cases) according to whether an eggshell vertebral body developed in the injured vertebra after internal fixation with posterior screw-rod system. The 2 groups were compared in terms of gender, age, follow-up time, body mass index, history of primary hypertension, history of diabetes mellitus, vertebral bone quality (VBQ) score, local Cobb angle correction, presence or absence of screwing at the injured vertebra, fracture site, fracture type, presence or absence of injury to the posterior ligamentous complex, presence or absence of injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rates of the anterior, middle, and posterior heights of the injured vertebra, and preoperative and postoperative visual analog scale (VAS) for pain. After positive indicators were screened by univariate analysis ( P<0.05), they were included in a multivariate logistic regression model and receiver operating characteristic curve (ROC) to analyze the risk factors for the formation of eggshell vertebral body after posterior screw-rod internal fixation of thoracolumbar spine fractures. Results:Of the 118 patients, 47 developed an eggshell vertebral body after surgery. Univariate analysis showed that VBQ score, presence or absence of screwing at the injured vertebra, burst fracture type, injury to the posterior ligamentous complex, injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rate of the anterior height of the injured vertebra, recovery rate of the middle height of the injured vertebra were statistically significant ( P<0.05). The multivariate logistic regression analysis and ROC curve analysis showed that a VBQ score ≥ 2.95 points( OR=6.216, 95% CI: 1.890 to 20.441, P=0.003), a recovery rate of the anterior height of the injured vertebra ≥ 25.26% ( OR=1.097, 95% CI: 1.046 to 1.149, P<0.001), a burst fracture type ( OR=6.397, 95% CI: 1.733 to 23.617, P=0.005), and injury to the upper and lower discs/endplate complex in the injured vertebrae ( OR=7.581, 95% CI: 1.827 to 31.461, P=0.005) were significantly associated with the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures ( P<0.05). Conclusion:A VBQ score ≥ 2.95 points, a recovery rate of the anterior height of the injured vertebra ≥ 25.26%, a burst fracture type, and injury to the disc/endplate complex in the injured vertebrae are the independent risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures.

Objective:To investigate the risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures. Methods:A retrospective study was conducted to analyze the 118 patients with thoracolumbar single-segment fracture who had been treated at Department of Orthopaedic Surgery, The First Hospital Affiliated to Soochow University between January 2020 and January 2023. The patients were divided into a case group (47 cases) and a control group (71 cases) according to whether an eggshell vertebral body developed in the injured vertebra after internal fixation with posterior screw-rod system. The 2 groups were compared in terms of gender, age, follow-up time, body mass index, history of primary hypertension, history of diabetes mellitus, vertebral bone quality (VBQ) score, local Cobb angle correction, presence or absence of screwing at the injured vertebra, fracture site, fracture type, presence or absence of injury to the posterior ligamentous complex, presence or absence of injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rates of the anterior, middle, and posterior heights of the injured vertebra, and preoperative and postoperative visual analog scale (VAS) for pain. After positive indicators were screened by univariate analysis ( P<0.05), they were included in a multivariate logistic regression model and receiver operating characteristic curve (ROC) to analyze the risk factors for the formation of eggshell vertebral body after posterior screw-rod internal fixation of thoracolumbar spine fractures. Results:Of the 118 patients, 47 developed an eggshell vertebral body after surgery. Univariate analysis showed that VBQ score, presence or absence of screwing at the injured vertebra, burst fracture type, injury to the posterior ligamentous complex, injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rate of the anterior height of the injured vertebra, recovery rate of the middle height of the injured vertebra were statistically significant ( P<0.05). The multivariate logistic regression analysis and ROC curve analysis showed that a VBQ score ≥ 2.95 points( OR=6.216, 95% CI: 1.890 to 20.441, P=0.003), a recovery rate of the anterior height of the injured vertebra ≥ 25.26% ( OR=1.097, 95% CI: 1.046 to 1.149, P<0.001), a burst fracture type ( OR=6.397, 95% CI: 1.733 to 23.617, P=0.005), and injury to the upper and lower discs/endplate complex in the injured vertebrae ( OR=7.581, 95% CI: 1.827 to 31.461, P=0.005) were significantly associated with the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures ( P<0.05). Conclusion:A VBQ score ≥ 2.95 points, a recovery rate of the anterior height of the injured vertebra ≥ 25.26%, a burst fracture type, and injury to the disc/endplate complex in the injured vertebrae are the independent risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures.

With the aging population, the increasing incidence of adult spinal deformity (ASD) associated with osteoporosis (OP) presents new challenges for evaluation and management. Although reasonable and standardized non-surgical treatment remains the first choice in the early stages of this disease, surgical treatment is necessary for patients with severe deformities and significant symptoms to achieve further improvement. Proximal junctional kyphosis/failure (PJK/PJF) is one of the most serious postoperative complications of ASD. Careful and comprehensive preoperative evaluation of bone quality and body sagittal alignment is crucial for the successful implementation of the operation. The Hounsfield unit (HU) based on CT imaging and the vertebral bone quality (VBQ) score based on MRI have proven to be reliable, effective, simple, and widely used in evaluating local vertebral bone quality in recent years. For the evaluation and prediction of PJF after ASD, the bone quality of the upper instrumented vertebra (UIV) can be assessed using HU values to identify high-risk patients and implement preventive measures. The VBQ score is predictive of the incidence of PJK/PJF in patients undergoing ASD surgery, with a high VBQ score being one of the risk factors for PJK/PJF after ASD correction. Patients with high VBQ scores can delay surgery and use anti-osteoporosis drugs before surgery to reduce the occurrence of PJK/PJF. Meanwhile, reasonable and personalized recovery parameters of ASD patients' sagittal sequence can help balance the benefits of efficacy and complications, maximizing the overall benefits. The prevention of PJK/PJF is challenging due to the stress gap between the internal fixation area and the original unfixed tissue area in the postoperative proximal junctional area, which is increasingly significant in OP patients. It is necessary to improve the fixation strength and bone riveting strength of the proximal junction area properly and to gradually decrease the fixed strength in the proximal junctional area to achieve a smooth transition of stress and avoid stress concentration resulting in failure. Relevant strategies include: 1. Enhanced proximal junction fixation, such as vertebral cement-enhanced pedicle screw fixation. 2. Strategies to cushion the stress in the proximal junction, such as Topping-off technology, which includes laminar/transverse hooks, dynamic rods, multi-segment stabilization screws, and multiple ligament-binding straps. 3. Minimally invasive technology can better protect the soft tissues such as the posterior ligament complex and muscles, reduce iatrogenic injury, and thus reduce the incidence of PJK/PJF. Currently, there are many controversies about the optimal treatment for ASD with OP, but the goal is to achieve maximum efficacy while minimizing complications. Additionally, attention should be paid to reasonable and standard anti-osteoporosis treatment in the perioperative period. This paper summarizes the relevant studies used to evaluate PJK/PJF after ASD in patients with OP and reviews the research progress on PJK/PJF prevention strategies, providing reference and ideas for reducing postoperative proximal junctional complications in adult spinal deformity patients with osteoporosis.

Objective:To understand the basic information such as age,job title,and education of rehabilita-tion therapists in the Grade Ⅲ public psychiatric hospitals in China,and provide fundamental data for the construc-tion of the mental health rehabilitation talent team.Methods:The staffing of rehabilitation therapists in 43 Grade Ⅲpublic psychiatric hospitals in eastern,central,and western regions of China were investigated.The age,education,job title,professional relevance and inter-regional differences of the rehabilitation therapists were statistically ana-lyzed.Results:There were 197 rehabilitation therapists in 43 hospitals surveyed.The age distribution was mainly in 20-30 and 30-40 years old with a bachelor's degree and junior,and more than half of the personnel had their first academy degree related to the rehabilitation profession.The differences in age,education,job title were statistically significant in the eastern,central and western regions.Conclusion:The overall quality of the rehabilitation therapists in China's Grade Ⅲ public psychiatric hospitals is relatively high,and the age structure is reasonable.However,the proportion of senior professional titles is relatively low.Therefore,it is necessary to focus on talent training and the establishment of promotion systems in the future,in order to improve the professional development space and level of the entire industry.

Objective:To analyze the risk factors for residual pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVF).Methods:Retrospectively analyzed were the patients with OVC who had been treated at Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University by single level PKP from January 2020 to December 2021. They were 40 men and 181 women, with an age of (69.6±8.2) years. By the pain score of visual analogue scale (VAS) on the postoperative day 3, they were assigned into 2 groups: a residual pain group (VAS≥4) and a control group (VAS<4). The general demographics, radiographic and surgical related data of the 2 groups were analyzed by single factor analysis, including their gender, age, bone mineral density, body mass index, glucocorticoid usage, follow-up time, duration of symptoms, fracture location, severity of fracture compression, intravertebral cleft, middle column involvement, thoracolumbar fascia injury, anesthesia method, puncture method, volume of bone cement injected, cement-endplates contact, pattern of cement distribution, cement leakage, vertebral height restoration, preoperative cobb angle and correction of cobb angle. The P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:In the present study, 19 patients were assigned into the residual pain group and 202 patients the control group. The univariate analysis showed that body mass index ( P=0.059), intravertebral cleft ( P=0.049) and thoracolumbar fascia injury ( P< 0.001) increased the risk for residual pain. The multivariate logistic regression analysis showed that thora-columbar fascia injury was an independent risk factor for residual pain ( OR=6.127, 95% CI: 2.240 to 16.755, P<0.001). Conclusion:Thoracolumbar fascia injury is an independent risk factor for residual pain after PKP for OVF.

Diabetic retinopathy （DR） is one of the most common chronic microvascular complications of diabetes mellitus. It has a high rate of blindness， and the age of onset is gradually getting younger， which seriously affects the physical and mental health and quality of life of patients. The disease is retinal damage induced by diabetes mellitus， which is a kind of fundus disease with the main manifestations of fundus hemorrhage， hard exudation， microhemangioma， cotton-wool spots， neovascularization， etc. In traditional Chinese medicine （TCM）， it is classified into the category of "diabetic cataracts" and other diseases. At present， there is no effective method to prevent the progress of the disease in modern medicine， so it is particularly important to choose a reasonable and effective intervention to prevent and treat DR. Studies have confirmed that TCM has unique advantages in the treatment of DR. It can use its advantages of multiple bioactive components， multiple targets， and multiple pathways to intervene in the development process of DR from various aspects. By searching for the relevant literature on the progress of the intervention of DR with TCM monomers and compounds， this paper mainly reviews the relevant research results of the treatment of DR with multiple signaling pathways such as phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， nuclear factor kappa-B（NF-κB）， p38 mitogen-activated protein kinase （p38 MAPK）， nuclear factor erythroid 2-related factor （Nrf2）/hemeoxygenase-1 （HO-1）， Hippo， advanced glycation end products （AGEs）/receptor for advanced glycation end products （RAGE）， and Akt/glycogen synthase kinase-3β （GSK-3β）， so as to provide more ideas and directions for the clinical prevention and treatment of DR.

As a threat to human health， steroid-induced osteonecrosis of femur head is a common refractory orthopedic disease mainly caused by glucocorticoids， with poor prognosis and unclear pathogenesis. Osteogenesis-associated signaling pathways play an important role in bone formation. Glucocorticoid-induced abnormal activation and transport of these signaling pathways lead to abnormal differentiation of bone marrow mesenchymal stem cells， dysfunction of bone metabolism， and osteogenesis disorders， which may be the main reasons for the occurrence and development of steroid-induced osteonecrosis of femur head. Bone formation and remodeling need the participation of bone marrow mesenchymal stem cells， which are stem cells characterized by continuous self-renewal and differentiation. The key to strengthening bone remodeling is to improve the osteogenic differentiation capacity， which is the key point to inhibit bone resorption and prevent bone marrow mesenchymal stem cells from differentiating into osteoclasts. Traditional Chinese medicine （TCM） has been used in the treatment of osteonecrosis in ancient times. It is recorded in the Treasury of Words on Materia Medica （《本草汇编》） that "The deficiency in the lower energizer cannot be tonified without Eucommiae Cortexz.The soreness in lower legs cannot be alleviated without Eucommiae Cortex...The pain in the waist and knee cannot be relieved without Eucommiae Cortex...Tonifying liver and invigorating kidney， Eucommiae Cortex is an essential medicine." This indicates that ancient physicians have already begun to use the liver-tonifying， kidney-invigorating， and sinew-bone-strengthening effects of Eucommiae Cortex for the treatment of osteonecrosis. As the national support for the development of TCM strengthens， increasing studies have been conducted on the TCM prevention and treatment of steroid-induced osteonecrosis of femur head. Studies have suggested that Chinese medicinal herbs can exert a positive effect on the differentiation of bone marrow mesenchymal stem cells by affecting targeted signaling molecules， and promote osteogenesis and bone defect repair， thus combating the occurrence and development of steroid-induced osteonecrosis of femur head. The regulation of osteogenic signaling pathway by Chinese medicines to prevent steroid-induced osteonecrosis of femoral head has become a hot research topic. This article reviews the studies about the prevention and treatment of steroid-induced osteonecrosis of femur head with the active components in Chinese medicinal herbs by regulating osteogenic signaling pathways. We then explore the mechanism of the active components in promoting the differentiation of bone marrow mesenchymal stem cells into osteoblasts and inhibiting their differentiation into osteoclasts to facilitate bone formation， aiming to provide a reference for the further study of treating steroid-induced osteonecrosis of femoral head with Chinese medicinal herbs.

Objective:To explore the characteristics and differences of oxygenated hemoglobin responses in different brain regions in adolescent depressive disorder patients and healthy adolescents during speech fluency task based on functional near-infrared spectroscopy imaging.Methods:From March 2021 to June 2021, twenty-nine adolescents with depression(depressed group) and 26 healthy adolescents(normal group) were enrolled. The severity of depression was assessed by Hamilton depression scale, and the speech fluency task was performed by functional near-infrared spectroscopy brain imaging, and the relative concentrations of oxyhemoglobin in the prefrontal and bilateral temporal lobes were measured.SPSS 26.0 statistical software was used for data analysis, chi-square test was used for gender count data. The t-test was used for comparison of two groups. The measurement data that did not conform to normal distribution were compared between the two groups by Mann-Whitney U test. Results:In the speech fluency task, there was no significant difference in the concentration of oxygenated hemoglobin in prefrontal and left temporal between the depressed group and the normal group (both P>0.05); the oxygenated hemoglobin concentration in the right temporal lobe(-9.179(-22.231, 4.789)) of depressed group was significantly lower than that of the normal group (12.754(-9.438, 35.008)), and the difference was statistically significant ( U=538.00, P<0.05). The oxygenated hemoglobin concentration in right temporal lobe of depressed group had no correlation with the score of Hamilton depression rating scale ( r=0.092, P>0.05). Conclusion:The right temporal lobe function of adolescent depression patients is lower than that of healthy controls during speech fluency tasks, which provides a basis for study of the relationship between depression and some cognitive sensitivity impairment and the function of right temporal lobe.

Objective:To investigate the dose-effect relationship of alfentanil inhibiting cardiovascular responses to tracheal intubation when combined with midazolam and etomidate.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<32 kg/m 2, undergoing elective operation under general anesthesia with endotracheal intubation, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, and 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at an interval of 3 min, and the mean value was calculated and served as the baseline value.Etomidate 0.3 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60, and then 1.4 min later tracheal intubation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 20 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular responses to tracheal intubation, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response was defined as as positive when the maximum value of mean arterial pressure or heart rate increased by ≥20% of the baseline value within 2 min after endotracheal intubation.Probit method was used to determine the ED 50, ED 95 and 95% confidence interval of alfentanil inhibiting cardiovascular responses to tracheal intubation. Results:When combined with midazolam and etomidate, the ED 50 (95% confidence interval) of alfentanil inhibiting cardiovascular responses to tracheal intubation was 21.343 (19.105-24.516) μg/kg, and the ED 95 (95% confidence interval) was 25.043 (22.983-48.983) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting cardiovascular responses to tracheal intubation are 21.343 and 25.043 μg/kg, respectively.