Objective To investigate the the effects of fracture fragment size and fixation method on biomechanical stability of distal tibial epiphyseal injuries in children.Methods A three-dimensional(3D)finite element model of a Salter-Harris Ⅱ(SH-Ⅱ)epiphyseal injury with fracture fragments of varying sizes(Small,Middle,Big)was constructed using computed tomography(CT)data from the lower limb of a 10-year-old volunteer.and bone-internal fixation assemblies were created with 1-3 screws(1 S group,2 S group,3 S group)and Kirschner wire(K group).The model was subjected to gravitational forces,posterior drawer forces,and external rotation.Displacement and stress distributions on fracture fragments and fixation devices were analyzed.Results The maximum displacement for the four groups of models was concentrated at the distal end of the fracture fragment.Under gravity conditions,the maximum displacement of the distal end of the fracture fragment in the 1 S,2 S,3 S and K models in Small group was 5.69,5.57,5.56,0.11 mm,respectively,and the bone stress was 16.95,12.26,8.57 and 5.00 MPa,respectively.A high stress area at the epiphyseal plate and the fracture line was easily formed under screw fixation,while a high stress area at the edge of the epiphyseal plate was formed under Kirschner wire fixation.Conclusions When distal tibial epiphyseal injuries in children are treated by using screws,increasing the number of screws can improve the fixation stability and share local bone stress,but the connection area between the fracture fragment and the epiphyseal plate cannot be too small.Kirschner wire fixation can provide better biomechanical effects than screw fixation.

Objective:To explore the establishment, implementation, and application effect of the annual progressive assessment mode for standardized training of resident physicians in a medical laboratory base.Methods:Since 2020, the base has improved the annual progressive assessment system through assessment system establishment, question bank construction, routine assessment, rotation examination, and annual examination. This new assessment mode was adopted for the residency trainees enrolled in the base after 2020. The control group consisted of seven residency trainees enrolled before 2020, while the experimental group comprised 13 trainees enrolled in 2020 and later. The two groups were compared based on the rotation and annual examination scores of second- and third-year trainees, as well as their academic achievements. Additionally, teaching outcomes of the base before and after 2020 were analyzed. The t test, rank-sum test, and Fisher's exact test were performed using SPSS 27.00. Results:There were no significant differences in age, sex, and education level between the two groups. The experimental group showed significantly higher scores than the control group in theory assessment ( P<0.001 for second-year trainees and P=0.008 for third-year trainees) and skill assessment ( P<0.001 for second-year trainees and P=0.038 for third-year trainees) in rotation examination, as well as in theory assessment (both P<0.001) and skill assessment (both P<0.001) in annual examination. The improvement was particularly pronounced among second-year trainees. The trainees of the experimental group submitted 17 case reports in three years, and won awards at national conferences, provincial conferences, and institutional case speech competitions. In a national academic conference, the trainees won the second prize of "Excellent Case". Since 2020, we have been granted with our first teaching reform project and published our first teaching article. To date, we have obtained five teaching reform projects, published six teaching articles, and won multiple awards in provincial and institutional teaching competitions. Conclusions:The establishment of the annual progressive assessment mode is critical for training high-quality laboratory physicians, and puts forward higher requirements for residency training teachers.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Guidelines for Digital Ancient Books of TCM Indexing(T/CIATCM 119-2024)is based on the theoretical knowledge,disciplinary methods,and practical applications of TCM classical cataloging.Taking digital ancient books of TCM as the object,it systematically reveals the content of TCM knowledge,which is an essential indexing processing standard for building an intelligent retrieval system for TCM ancient books,and can provide support for the deep development and innovative utilization of TCM knowledge.It can not only promote the co-construction and sharing of ancient book resources in the TCM industry,but also promote the standardization construction and application of TCM information.This standard specifies the principles,methods,and examples of free indexing of digital ancient books of TCM based on their original content.It is applicable to the indexing and processing of digital ancient books of TCM for TCM professional libraries and related institutions,and to the data processing and construction of various types of TCM ancient book databases.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Guidelines for Digital Ancient Books of TCM Indexing(T/CIATCM 119-2024)is based on the theoretical knowledge,disciplinary methods,and practical applications of TCM classical cataloging.Taking digital ancient books of TCM as the object,it systematically reveals the content of TCM knowledge,which is an essential indexing processing standard for building an intelligent retrieval system for TCM ancient books,and can provide support for the deep development and innovative utilization of TCM knowledge.It can not only promote the co-construction and sharing of ancient book resources in the TCM industry,but also promote the standardization construction and application of TCM information.This standard specifies the principles,methods,and examples of free indexing of digital ancient books of TCM based on their original content.It is applicable to the indexing and processing of digital ancient books of TCM for TCM professional libraries and related institutions,and to the data processing and construction of various types of TCM ancient book databases.

Objective:To analyze the applied effect of artificial intelligence(AI)rehabilitation system combined with telemedicine platform in individualized rehabilitation treatment for patients with long-term coma,so as to realize individual management for them.Methods:An AI rehabilitation system that aimed to patients with long-term coma was designed by integrating data of multimodal sensors included inertial sensor,image sensor and bioelectric sensor.A telemedicine platform,which included seven modules(patient management,consultation management,video communication,data transmission,electronic medical records,cost management and system maintenance),was designed by using a browser/server(B/S)architecture.The changes of patients'condition were followed up,and the full process of the management for rehabilitation treatment and the individualization of treatment plan were realized.A total of 60 inpatients whose coma duration exceeded 28 days were selected from the Coma Awakening Center of Dongguan Shipai Hospital between October 1,2021 and September 30,2022.They were randomly divided into control group(n=30)and observation group(n=30)by random number table.The control group received physical therapy and rehabilitation training based on evaluation results of rehabilitation,while the observation group adopted AI rehabilitation system combined with the telemedicine platform to conduct intervention.The consciousness levels,quality of life,hospital stay duration and treatment costs of two group were compared after intervention.Results:The Glasgow Coma Scale(GCS)scores,Coma Recovery Scale-Revised(CRS-R)scores,and Persistent Vegetative State(PVS)scores of two groups after intervention were significantly higher than those before intervention,and these indicators of observation group were significantly higher than them of control group after intervention,and the differences were significant(t=7.187,15.586,9.293,P<0.05),respectively.There were not significant differences in Glasgow Outcome Scale(GOS)scores and Activities of Daily Living(ADL)scores between two groups before intervention(P>0.05),and these scores of two groups were significantly increased after intervention,and these scores of observation group were significantly higher than them of control group after intervention,and the differences were significant(t=7.584,6.755,P<0.05).Additionally,the hospital stay duration and treatment costs of observation group were significantly less than those of control group,and the differences were significant(t=20.965,9.503,P<0.05).Conclusion:The intervention of AI rehabilitation system combines with a telemedicine platform on patients with long-term coma can enhance GCS,CRS-R,PVS,GOS and ADL scores,and reduce hospital stay duration and treatment cost.

Objective:To analyze the dynamic changes of serum exosome miR-552 and miR-653 levels in pa-tients with gastric cancer before and after chemotherapy and their relationship with clinical benefit.Methods:IA total of 128 patients with gastric cancer received chemotherapy from January 2022 to January 2024.According to the chemo-therapy effect,the two groups were divided into disease progression group and disease remission group.The levels of serum exosome miR-552 and miR-653 before and after chemotherapy were detected in the two groups,the risk fac-tors affecting the chemotherapy effect of gastric cancer patients were screened,the risk nomogram model was con-structed,and the efficacy was evaluated.Results:The proportion of TNM stage(Ⅲ+Ⅳ),lymph node metastasis,dis-tant metastasis,tumor size(>5 cm),invasion depth(T3/T4)and tumor growth pattern(invasive type)in disease progres-sion group was higher than that in disease remission group(P<0.05).The levels of serum exosomes miR-552 and miR-653 in disease progression group were higher than those in remission group before and after chemotherapy(P<0.05).Compared with before chemotherapy,miR-552 and miR-653 levels in both groups decreased(P<0.05).Logistic regres-sion analysis showed that TNM stage,lymph node metastasis,distant metastasis,tumor size,invasion depth,miR-552 and miR-653 were all risk factors affecting the chemotherapy efficacy of gastric cancer(P<0.05).ROC curve results showed that the AUC,95%CI,sensitivity and specificity of risk nomogram model to predict chemotherapy efficacy of gastric cancer were 0.867,0.672～0.991,92.80%and 80.40%,respectively(P<0.001).Calibration curve results showed that both predicted and actual predicted values were near the ideal curve,and the Hosmer-Lemeshow goodness of fit curve test χ2=1.869,P=0.782.Conclusion:The levels of serum exosomes miR-552 and miR-653 are closely related to the chemotherapy efficacy of gastric cancer,and dynamic monitoring of the above indexes is helpful for the evaluation of the disease and prognosis of gastric cancer.In this study,the risk nomogram model constructed based on the above indexes and other risk factors has high predictive value and clinical practicability for chemotherapy efficacy in patients with gastric cancer.

Objective To comparatively analyze the quantitative parameters of culprit and non-culprit plaques in patients with acute coronary syndromes(ACS)with a noninvasive technique of coronary computed tomography angiography(CCTA),and to explore the correlation between the quantitative parameters of plaques and culprit plaques.Methods Data were restrospectively collected from 51 ACS patients admitted in some hospital from January to December 2021.The coronary atherosclerotic plaques shown by invasive catheter angiography(ICA)that caused hemodynamic abnormalities and were treated with stenting were defined as offender plaques and enrolled into a culprit plaque group(56 culprit plaques),and other plaques were regarded as non-culprit plaques and divied into a non-culprit plaque group(164 non-culprit plaques).The relationship between culprit plaque and luminal stenosis was analyzed using the chi-square test,and quantitative plaque metrics were compared between the groups.The corelation between quantitative indicators and culprit plaque was analyzed using univariate Logistic regression,and multifactorial Logistic regression analysis was carried out.Statistical analysis was performed with SPSS 23.0 software.Results Analysis of plaque imaging data showed that culprit plaque was significantly associated with the degree of luminal stenosis(P<0.05).Statistically significant differences were found beween the two groups and between the culprit plaques resulting in moderate or greater luminal stenosis and non-culprit plaques in total plaque length,total plaque load,calcification load,fibrolipid volume,fibrolipid load,necrotic core volume and necrotic core load(all P<0.05).Univariate Logistic regression analysis showed total plaque length,total plaque load,fibrolipid volume,fibrolipid load,necrotic core volume and necrotic core load were all significantly correlated with culprit plaques(all P<0.05);multifactorial Logistic regress indicated total plaque length and fibrous lipid load were independent risk factors for culprit plaques,and the probability of culprit plaques increased to 1.093 and 1.101 times for every one unit increase in total plaque length and fibrolipid load,respectively.Conclusion Such quantitative parameters of plaques as total plaque length,total plaque load,fibrolipid volume,fibrolipid load,necrotic core volume and necrotic core load reflects the characteristics of culprit plaques effectively.Quantitative plaque parameter analysis based on CCTA facilitates clinicians for early assessment of patients with coronary atherosclerosis,which enables early intervention and prevention of acute coronary syndromes.[Chinese Medical Equipment Journal,2025,46(6):65-71]

Oropharyngeal squamous cell carcinoma(OPSCC)is a malignant tumor originating from the squamous epithelium of the oro-pharyngeal mucosa,accounting for more than 90％of oropharyngeal malignancies.In recent years,human papillomavirus(HPV)infec-tion has become one of the primary etiological factors of oropharyngeal squamous carcinoma.The incidence of HPV-associated oropharyn-geal squamous carcinoma has been rising annually,with a noticeable trend toward younger populations,posing a significant threat to hu-man health.Due to the distinct biological behavior and clinical characteristics of HPV-associated oropharyngeal squamous carcinoma com-pared to its non-HPV-related counterpart,the diagnostic and treatment strategies for oropharyngeal squamous carcinoma have undergone substantial changes.Prevention and screening for oropharyngeal squamous carcinoma are of critical importance.The diagnostic and treat-ment process involves multi-disciplinary collaboration,including oral and maxillofacial surgery,otolaryngology,head and neck surgery,oncology,radiology and pathology.Based on evidence from clinical practice,a comprehensive,integrated diagnostic and therapeutic ap-proach has been established,centered around the concept of"prevention,screening,diagnosis,treatment,and rehabilitation",covering the entire patient lifecycle and providing a valuable reference for clinical practice.