Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

OBJECTIVES: Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) are the 2 most common chronic middle ear diseases. In the process of diagnosis and treatment, the 2 diseases are prone to misdiagnosis and missed diagnosis due to their similar clinical manifestations. High resolution computed tomography (HRCT) can clearly display the fine anatomical structure of the temporal bone, accurately reflect the middle ear lesions and the extent of the lesions, and has advantages in the differential diagnosis of chronic middle ear diseases. This study aims to develop a deep learning model for automatic information extraction and classification diagnosis of chronic middle ear diseases based on temporal bone HRCT image data to improve the classification and diagnosis efficiency of chronic middle ear diseases in clinical practice and reduce the occurrence of missed diagnosis and misdiagnosis. METHODS: The clinical records and temporal bone HRCT imaging data for patients with chronic middle ear diseases hospitalized in the Department of Otorhinolaryngology, Xiangya Hospital from January 2018 to October 2020 were retrospectively collected. The patient's medical records were independently reviewed by 2 experienced otorhinolaryngologist and the final diagnosis was reached a consensus. A total of 499 patients (998 ears) were enrolled in this study. The 998 ears were divided into 3 groups: an MEC group (108 ears), a CSOM group (622 ears), and a normal group (268 ears). The Gaussian noise with different variances was used to amplify the samples of the dataset to offset the imbalance in the number of samples between groups. The sample size of the amplified experimental dataset was 1 806 ears. In the study, 75% (1 355) samples were randomly selected for training, 10% (180) samples for validation, and the remaining 15% (271) samples for testing and evaluating the model performance. The overall design for the model was a serial structure, and the deep learning model with 3 different functions was set up. The first model was the regional recommendation network algorithm, which searched the middle ear image from the whole HRCT image, and then cut and saved the image. The second model was image contrast convolutional neural network (CNN) based on twin network structure, which searched the images matching the key layers of HRCT images from the cut images, and constructed 3D data blocks. The third model was based on 3D-CNN operation, which was used for the final classification and diagnosis of the 3D data block construction, and gave the final prediction probability. RESULTS: The special level search network based on twin network structure showed an average AUC of 0.939 on 10 special levels. The overall accuracy of the classification network based on 3D-CNN was 96.5%, the overall recall rate was 96.4%, and the average AUC under the 3 classifications was 0.983. The recall rates of CSOM cases and MEC cases were 93.7% and 97.4%, respectively. In the subsequent comparison experiments, the average accuracy of some classical CNN was 79.3%, and the average recall rate was 87.6%. The precision rate and the recall rate of the deep learning network constructed in this study were about 17.2% and 8.8% higher than those of the common CNN. CONCLUSIONS The deep learning network model proposed in this study can automatically extract 3D data blocks containing middle ear features from the HRCT image data of patients' temporal bone, which can reduce the overall size of the data while preserve the relationship between corresponding images, and further use 3D-CNN for classification and diagnosis of CSOM and MEC. The design of this model is well fitting to the continuous characteristics of HRCT data, and the experimental results show high precision and adaptability, which is better than the current common CNN methods.
Algorithms ; Ear Diseases ; Humans ; Neural Networks, Computer ; Retrospective Studies ; Tomography, X-Ray Computed/methods*

Objective To explore the clinical application of case teaching method combined with clinical pathway in pediatrics teaching.Methods 103 students in pediatric practice from September 2016 to September 2017 were enrolled as the study object,who were divided randomly into observation group (52 cases) and control group (51 cases).Routine teaching method was adopted in the control group,while case teaching method combined with clinical pathway was adopted in the observation group.In addition,100 cases of children in need of rescue were selected for each group and the students were divided into two or three in a group to participate in the rescue.If the student could complete the rescue with the assistance of supervisor,he will be considered as playing a leading role in rescue process.Otherwise,another supervisor would join to lead the rescue,and the student would assist by the side,who will be considered as playing an auxiliary role in rescue process.The results of examination,classroom participation,homework,the rescue performance and the satisfaction of teaching were compared between two groups.Results The scores of theoretical course,case analysis and skill operation in the observation group was significantly higher than that of the control group (P＜0.05).The scores of classroom attendance,classroom activity and homework quality in the observation group was significantly higher than that of the control group (P＜0.05).Success rate of rescue conducted by students in the observation group was significantly higher than that in the control group(P＜0.05).The teaching satisfaction of the observation group was also significantly higher than that of the control group (P＜0.05).Conclusion The application of case teaching method combined with clinical pathway teaching model in pediatrics teaching is effective and worthy of popularizing,which can obviously improve teaching quality,arouse students' interest in teaching process,and improve students' professional quality.

OBJECTIVE: To observe the differences in the sleep quality and the effects on insomnia severity between 's three-promotion needling method and the oral administration of estazolam. METHODS: A total of 70 patients of subacute insomnia were randomized into a three-promotion needling group and a medication group, 35 cases in each one. In the three-promotion needling group, the mild promotion technique with the filiform needle, the warm promotion technique with the fire needle and the strong promotion technique with the three-edged needle were adopted in combination. The acupuncture with the filiform needle was used at Baihui (GV 20), Sishencong (EX-HN1), Shenting (GV 24), Shenmen (HT 7), etc, The treatment was given 3 times a week, once every 2 days. The pricking technique with fire needle was applied to Ganshu (BL 18), Xinshu (BL 15), Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23) and Geshu (BL 17), once every 3 days, twice a week. The bleeding technique with the three-edged needle was used at the ear apex, once every 2 days, 3 times a week. In the medication group, the estazolam tablets were taken orally before sleep, 1mg once every 2 days. The treatment was given consecutively for 4 weeks in the two groups. Separately, before treatment, in 2-week treatment and in 4-week treatment as well as in 1-month follow-up after treatment, the Pittsburgh sleep quality index (PSQI) and the insomnia severity index (ISI) scores were recorded in the patients of the two groups. The clinical effects were evaluated in the two groups. RESULTS: In 2 weeks and 4 weeks of treatment, as well as in the follow-up, PSQI scores and ISI scores were all reduced obviously as compared with those before treatment in the two groups (all <0.05). In the three-promotion needling group, the PSQI score at each time point was reduced much more obviously as compared with the medication group (all <0.05). In the follow-up, the ISI score in the three-promotion needling group was lower than the medication group (<0.05). The total effective rates were 97.2% (34/35) and 91.4% (32/35) at the end of treatment and in the follow-up respectively in the three-promotion needling group, higher than 85.7% (30/35) and 71.4% (25/35) in the medication group (both <0.05). CONCLUSION 's three-promotion needling method much more effectively improves the sleep quality and reduces insomnia severity in the patients of subacute insomnia. This therapy presents the satisfactory short-term and long-term effects.
Acupuncture Points ; Acupuncture Therapy ; Estazolam ; Humans ; Sleep Initiation and Maintenance Disorders ; therapy ; Treatment Outcome

Objective To evaluate and compare the short-term effects of two kinds of plastic mulch on Oncomelania hupensis snail control in irrigation and drainage ditches with snails in Yunnan Province. Methods The irrigation and drainage ditches with high density of Oncomelania hupensis snails were chosen as the investigation sites,and then 4 groups were set,namely a colorless plastic mulch group,black plastic mulch group,colorless plastic mulch with molluscicide group and black plastic mulch with molluscicide group. The snail situation of the 4 groups was surveyed before the experiment and 7,14,21,30 days after covering plastic mulch,and the snail death rates were compared among the 4 groups. Meanwhile,the hourly temperatures of soil surface,soil surface under plastic mulch and soil layer 5,15 cm under the surface as well as the weather situation during the study period were measured and recorded. Results The average snail mortality rate of the colorless plastic mulch group was only 15.29% that was higher than that of the black plastic mulch group(6.56%)(P < 0.01). The average snail mortality rates of the colorless and black plastic mulch with molluscicide groups were 40.80% and 50.15%,respectively,and there was no statis-tic difference between them(P > 0.05). Both kinds of plastic mulches could raise the temperature of the soil surface under plas-tic mulch and the soil layer below it,and the temperature of soil under the mulches increased over the cover time,and the aver-age temperature of the soil surface under the black mulch in 30 days was higher than that under the colorless mulch. Conclu-sion It is not suitable to use plastic mulch only in irrigation and drainage ditches with snails widely in Yunnan Province be-cause of its low effect,and if necessary,the molluscicide should be added.

ObjectiveTo compare the clinical efficacies of acupuncture plus TDP lamp versus acupuncture plus moxibustion in treating rheumatoid arthritis.MethodOne hundred and fifty patients were randomly allocated to treatmentand control groups, 75 cases each. The treatment group received acupuncture plus moxibustion and the control group, acupuncture plus TDP radiation.Both groups were treated for two courses. The VAS scores and the clinical sign grades and scores were compared between the two groups before and after treatment.ResultThe VAS score and the clinical sign score improved in both groups after treatment compared with before (P<0.05). The total efficacy rate was 93.3% in the treatment group and 78.7% in the control group; there was a statistically significant difference between the two groups (P<0.05). The effect was better in the treatment group than in the control group.ConclusionAcupuncture plus moxibustion is more effective than acupuncture plus TDP lamp in treating rheumatoid arthritis.