Objective To construct an optimal prediction model of chickenpox in Urumqi, and to provide reference for formulating the prevention and control strategies of chickenpox. Methods The multivariate autoregressive moving average model (ARIMAX) and random forest model (RF) were established based on the monthly incidence of chickenpox in Urumqi from 2014 to 2018, and the monthly incidence of chickenpox in 2019 was used to test the models and evaluate their prediction effect. The prediction performance of the two models was compared, and the best model was selected to predict the incidence of chickenpox in Urumqi. Results The incidence of chickenpox in Urumqi showed a regular bimodal distribution with obvious seasonality, and it showed a slow upward trend from July 2014 to December 2019. The fitting model was ARIMA(0,1,0)(0,1,1)₁₂, the root mean square error (RMSE) and mean absolute error (MAE) of ARIMAX model training set were 1.29 and 0.95, respectively, and the RMSE and MAE of the test set were 1.88 and 1.44, respectively. The training set RMSE and MAE of RF model were 1.56 and 1.56, respectively, and the test set RMSE and MAE were 4.83 and 3.96, respectively. Conclusion The performance of ARIMAX model is better than that of RF model, which can better predict the incidence trend of chickenpox in Urumqi. It is necessary to optimize the prediction model according to the actual situation and provide scientific guidance for the prevention and control of chickenpox.

Medical institutions, with their clinical practice foundation and abundant human use experience data, have become important carriers for the inheritance and innovation of traditional Chinese medicine(TCM) and the "cradles" of the preparation of new TCM. To effectively promote the transformation of new TCM originating from the TCM clinical practice in medical institutions and establish an effective evaluation index system for the transformation of new TCM conforming to the characteristics of TCM, consensus experts adopted the literature research, questionnaire survey, Delphi method, etc. By focusing on the policy and technical evaluation of new TCM originating from the TCM clinical practice in medical institutions, a comprehensive evaluation from the dimensions of drug safety, efficacy, feasibility, and characteristic advantages was conducted, thus forming a comprehensive evaluation system with four primary indicators and 37 secondary indicators. The expert consensus reached aims to encourage medical institutions at all levels to continuously improve the high-quality research and development and transformation of new TCM originating from the TCM clinical practice in medical institutions and targeted at clinical needs, so as to provide a decision-making basis for the preparation, selection, cultivation, and transformation of new TCM for medical institutions, improve the development efficiency of new TCM, and precisely respond to the public medication needs.
Medicine, Chinese Traditional/standards* ; Humans ; Consensus ; Drugs, Chinese Herbal/therapeutic use* ; Surveys and Questionnaires

Among numerous medical imaging modalities, diffusion weighted imaging (DWI) is extremely sensitive to acute ischemic stroke lesions, especially small infarcts. However, magnetic resonance imaging is time-consuming and expensive, and it is also prone to interference from metal implants. Therefore, the aim of this study is to design a medical image synthesis method based on generative adversarial network, Stroke-p2pHD, for synthesizing DWI images from computed tomography (CT). Stroke-p2pHD consisted of a generator that effectively fused local image features and global context information (Global_to_Local) and a multi-scale discriminator (M ²Dis). Specifically, in the Global_to_Local generator, a fully convolutional Transformer (FCT) and a local attention module (LAM) were integrated to achieve the synthesis of detailed information such as textures and lesions in DWI images. In the M ²Dis discriminator, a multi-scale convolutional network was adopted to perform the discrimination function of the input images. Meanwhile, an optimization balance with the Global_to_Local generator was ensured and the consistency of features in each layer of the M ²Dis discriminator was constrained. In this study, the public Acute Ischemic Stroke Dataset (AISD) and the acute cerebral infarction dataset from Yantaishan Hospital were used to verify the performance of the Stroke-p2pHD model in synthesizing DWI based on CT. Compared with other methods, the Stroke-p2pHD model showed excellent quantitative results (mean-square error = 0.008, peak signal-to-noise ratio = 23.766, structural similarity = 0.743). At the same time, relevant experimental analyses such as computational efficiency verify that the Stroke-p2pHD model has great potential for clinical applications.
Humans ; Tomography, X-Ray Computed/methods* ; Diffusion Magnetic Resonance Imaging/methods* ; Cerebral Infarction/diagnostic imaging* ; Stroke/diagnostic imaging* ; Neural Networks, Computer ; Image Processing, Computer-Assisted/methods* ; Algorithms

ObjectiveTo explore the mechanism of Cangxi Tongbi capsules （CXTB） in regulating the p38 mitogen-activated protein kinase （p38 MAPK）/NOD-like receptor protein 3 （NLRP3）/cysteine protease-1 （Caspase-1） signaling pathway to inhibit pyroptosis of cartilage cells in knee osteoarthritis （KOA）. MethodSixty male SD rats were randomly divided into a sham operation group， a model group， low， medium， and high dose CXTB groups， and a positive control group， with 10 rats per group. The modified Hulth method was employed to establish a rat model of KOA. According to their respective assignments， rats were administered CXTB （0.25， 0.5， 1.0 g·kg^-1） and Celecoxib （24 mg·kg^-1） by gavage. The sham operation and model groups were given an equivalent volume of physiological saline. Treatment was performed once daily for 28 days. Micro-computed tomography （Micro-CT） was used to assess bone volume/total volume （BV/TV） and trabecular separation （Tb.Sp）. Joint degeneration was evaluated through hematoxylin-eosin （HE） staining， safranin-fast green （SO） staining， and Osteoarthritis Research Society International （OARSI） scoring. Western blot analysis was conducted to measure the expression levels of p38 MAPK， phosphorylated p38 MAPK （p-p38 MAPK）， NLRP3， Caspase-1， and gasdermin D （GSDMD） proteins. Real-time PCR was used to assess mRNA expression levels of p38 MAPK， NLRP3， Caspase-1， and GSDMD genes. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum concentrations of inflammatory cytokines including tumor necrosis factor-alpha （TNF-α）， interleukin-1 beta （IL-1β）， and interleukin-18 （IL-18）. After knee replacement surgery， cartilage tissue was analyzed using Western blot to assess the protein expression levels of p38 MAPK， p-p38 MAPK， NLRP3， Caspase-1， and GSDMD， and Real-time PCR was used to evaluate gene expression levels of p38 MAPK， NLRP3， Caspase-1， and GSDMD. ResultMicro-CT analysis revealed significant narrowing of the joint space and increased bone spur formation in KOA rats compared with the sham operation group， with a decrease in BV/TV ratio and an increase in Tb.Sp value （P<0.01）. Serum levels of TNF-α， IL-1β， and IL-18 were elevated （P<0.01）. The protein expression levels of p-p38 MAPK， NLRP3， Caspase-1， and GSDMD in cartilage were significantly increased （P<0.01）， and the mRNA expression levels of p38 MAPK， NLRP3， Caspase-1， and GSDMD were also enhanced （P<0.01）. Significant differences in protein expression of p-p38 MAPK， NLRP3， Caspase-1， and GSDMD were observed between normal and diseased cartilage tissues after knee replacement surgery （P<0.05）， and the gene expression of p38 MAPK， NLRP3， Caspase-1， and GSDMD were also significantly different （P<0.01）. HE and SO staining showed roughened joint surfaces， reduced cartilage thickness， and disordered cellular arrangement in KOA rats. OARSI scores were significantly higher （P<0.01）. Compared with the model group， treatment with low， medium， and high concentrations of CXTB resulted in increased BV/TV ratios and decreased Tb.Sp values in the knee joints of rats （P<0.01）. HE and SO staining indicated a trend towards smoother joint surfaces and reduced OARSI scores （P<0.01）. The protein expression levels of p-p38 MAPK， NLRP3， Caspase-1， and GSDMD were notably decreased （P<0.05）， as were the mRNA expression levels of p38 MAPK， NLRP3， Caspase-1， and GSDMD （P<0.01）. Additionally， serum concentrations of TNF-α， IL-1β， and IL-18 were significantly reduced （P<0.01）. ConclusionCXTB intervention may alleviate knee joint degeneration in KOA rats and inhibit the expression of inflammatory factors and pyroptosis of cartilage cells， thereby protecting cartilage. The underlying mechanism may involve modulation of the p38 MAPK/NLRP3/Caspase-1 signaling pathway.

BACKGROUND:One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases,but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation. OBJECTIVE:To observe the position relationship of nerve roots,intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology,and to provide a basis for the clinical operation of one-hole split endoscope surgery. METHODS:Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan.Mimics 17.0 software was imported to measure the related imaging parameters of L1/2 to L3/4 segments:(1)Measurement of vertical distance:In coronal view,the distance(a)from the intersection point of the medial facet of the superior articular process and the superior endplate(N)to the apex of the articular process(S);in the coronal view,the distance(b)from the sagittal intersection(M)of N and the inferior endplate to the apex of the inferior articular process(X).(2)Measured horizontal distance:the distance(c)between the cross-section of N and the lower edge of the outlet nerve root(N2);distance(d)between the cross-section of N and the intersection point of neural tissue(N1);N1 to N2 distance(e);distance(f)between the cross-section of M and the lateral edge of the nerve tissue(M1);M to M cross-section and exit nerve root intersection(M2)distance(g);distance(h)from M1 to M2;distance(i)from M2 to N1;distance(j)from the posterior edge of the articular surface(R)to M2 in sagittal view of the superior articular process. RESULTS AND CONCLUSION:(1)With the decrease of the segment,the distances a and b gradually increased,and the distance j gradually decreased.There was no significant difference between L1/2 and L2/3 segments(P>0.05).(2)With the decrease of the segment,distance d first decreased and then increased;distance f gradually decreased;distances c,e,g,h and i gradually increased;and there was no significant difference between L2/3 and L3/4 segments(P>0.05).(3)Distance i was the shortest distance without pulling nerve roots in the natural state,and the area of the safety zone was between four points M1,M2,N1,and N2.The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X,respectively,to expose the intervertebral space,and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots.(4)In conclusion,the upper lumbar vertebrae have unique anatomical characteristics.Based on the relevant measurements of nerve roots,spinal dura and intervertebral space,the parameters of the one-hole split endoscope technique are more accurate and safe during operation.

Objective:To assess the efficacy of a minimally invasive technique for repairing tibial plateau bicondylar fractures utilizing the double reverse traction repositor.Methods:A retrospective analysis was performed of the data of 31 patients (Schatzker V 17 cases, Schatzker VI 14 cases) who had been admitted to trauma center of Shandong provincial hospital affiliated to Shandong first medical university for tibial plateau bicondylar fractures from January 2017 to January 2022. There were 21 males and 10 females, aged from 18 to 67 years (average, 32.4±6.5 years). The intervention strategy comprised the use of a double reverse traction repositor and was augmented by precise screw fixation. A comprehensive set of parameters were measured, including time interval between injury and operation, operation time, blood loss, hospital stay, fracture healing time, incision complications. Postoperative assessments were made immediately and at the 12-month mark, including the evaluation of articular step-off height, medial tibial plateau angle, and posterior tibial slope angle. The evaluation also included thTime interval between injury and operation ranged from 5 to 11 days, with an average of 6.1±1.3 days. The surgical procedures varied in length from 70 to 160 minutes, averaging at 109.2±15.6 minutes. The volume of blood loss was noted to be between 90 to 380 ml, averaging at 176.5±20.8 ml. Hospitalization spanned from 10 to 15 days, with an average stay of 12.2 ±0.8 days. Over a follow-up duration of 12 to 20 months, averaging at 13.5±1.1 months, all patients achieved fracture union within a period of 11 to 20 weeks, with an average time of 14.6±1.5 weeks. The postoperative articular step-off was recorded at 0.45±0.13 mm immediately after surgery and 0.58±0.21 mm at the one-year follow-up. Similarly, the medial tibial plateau angle and posterior tibial slope angle showed marginal changes from the immediate postoperative period to the 12-month evaluation. Knee joint mobility at the one-year mark ranged impressively from 0° to 135°, with an average of 125.6°±2.1°. Functional outcomes as reflected by Rasmussen scores ranged from 18 to 28 points, with an average of 25.4±1.7 points. Pain, as assessed by the VAS, had a low score range of 0 to 2 points, averaging at 0.7±0.2 points. Notably, there were no postoperative complications associated with the incisions, such as fat liquefaction, infection, skin necrosis, or exposure of internal fixations. Additionally, no cases of delayed union or fixation failure were observed. Six patients had traumatic arthritis 1 year after operation.Conclusion:The minimally invasive double reverse traction repositor technique for tibial plateau bicondylar fracture repair is effective, warranting its broader application in orthopedic surgery.

Non-coding RNAs (ncRNAs), which are thought to regulate articular cartilage through endochondral osteogenesis, consist of mRNA-interfering complementary RNA (miRNA) and long non-coding RNAs (lncRNA). More and more experimental evidence reveals the role of ncRNAs in chondrocyte differentiation and the pathogenesis of several skeletal diseases, including osteoarthritis. In the past few years, increasingly sophisticated DNA sequencing methods and a large number of sepigenetic modifications have greatly contributed to our understanding of the pathophysiological mechanisms of osteoarthritis. Recent studies have revealed that RNA interacts with RNA-binding proteins, regulates gene transcription and protein translation, and is involved in various pathological processes in OA, promising to be a therapeutic target for osteoarthritis.

Objective:To investigate the basic characteristics and treatment of aseptic nonunion of femoral shaft in Xi'an Red Cross Hospital from 2013 to 2020.Methods:The data were analyzed retrospectively of the patients with aseptic nonunion of femoral shaft who had been treated at Department of Orthopaedics and Trauma, Red Cross Hospital Affiliated to Medical College, Xi'an Jiaotong University from January 2013 to December 2020. The patients' data from 2013 to 2016 were assigned into group A while those from 2017 to 2020 into group B. The data like gender, age and nonunion were statistically analyzed and compared between the 2 groups.Results:A total of 311 patients with aseptic nonunion of femoral shaft were diagnosed and treated during the 8 years, accounting for 54.6% (311/570) of the femur nonunion, 32.8% (311/949) of the lower extremity nonunion, 25.0% (311/1,242) of the extremity nonunion, and 22.7% (311/1,370) of the whole body nonunion. There were 244 males and 67 females; the majority of patients were in the age group of 21 to 50 (67.2%, 209/311). The occupation distribution was the most common in farmers (49.2%, 153/311). Traffic injury was the most common cause for primary fractures (40.8%, 127/311). The most common type of injury was closed injury (89.4%, 278/311); the most common type of nonunion was atrophic nonunion (87.8%, 273/311); intramedullary nailing was the main treatment for primary fractures (54.3%, 169/311); channel osteogenesis was the main treatment for secondary nonunion (62.1%, 193/311); autologous iliac bone grafting was the most common grafting for atrophic nonunion (83.5%, 228/311). Compared with group A, the proportion of aseptic nonunion of femoral shaft in group B increased by 9.2% in the femoral nonunions, by 6.9% in the lower extremity nonunions, and by 6.0% in the extremity nonunions, and by 5.2% in the whole body nonunions, showing statistically significant differences ( P < 0.05). There were significant differences in the types of nonunion, occupational distribution, first-stage fracture treatment, second-stage nonunion treatment, and bone grafting method between the 2 groups ( P < 0.05). Conclusions:The patients with aseptic nonunion of the femoral shaft were more common in young and middle-aged male heavy manual laborers, and the condition was increasing in recent years. The channel osteogenesis technique was still the preferred treatment method in the hospital investigated.

Objective:To investigate the effects of surgical revision for humeral shaft nonunion on health-related quality of life.Methods:The data of 62 patients were studied retrospectively who had been hospitalized at Department of Orthopaedics and Traumatology, Hong-Hui Hospital for humeral shaft nonunion from March 2013 to September 2018. They were 43 males and 19 females, aged from 20 to 73 years (average, 42.3 years). Their nonunions belonged to the atrophic type in 19 cases, to the ischemic type in 14 cases and to the hypertrophic type in 29 cases. Their demographic and clinical data, imaging manifestations and treatment methods were recorded and analyzed. The 12-item short form health survey (SF-12) and brief pain inventory (BPI) were used to evaluate their health-related quality of life and the Mayo elbow performance score (MEPS) was used to evaluate their elbow function.Results:Upon admission, their physical component summary (PCS) scored 24.3±5.2, mental component summary (MCS) 26.3±3.8, brief pain inventory- severity (BPI-S) 6.5±1.9, and brief pain inventory-interference (BPI-I) 6.7±2.5. At 1-year follow-up, their PCS averaged 43.6±8.1, MCS 34.7±4.4, BPI-S 4.9±1.2, and BPI-I 4.4±1.4. There were statistically significant differences between preoperation and postoperation in the above 4 groups of indicators ( P<0.05). Their MEPS at the last follow-up revealed a 95.2% rate of excellent elbow function (59/62). By comparison with the literature data, their postoperative PCS scores were not significantly different from those for the patients with Barrentt＇s esophagus, primary hypertension, chronic obstructive pulmonary disease and silicosis ( P>0.05). There was no significant difference either in the postoperative MCS scores between them and stroke patients ( P>0.05). Conclusions:As a destructive chronic disease, humeral shaft nonunion has negative effects on physical and mental health and quality of life of the patients. Although the pain effect on the limb can be alleviated by surgical revision, the entire treatment may cause permanent psychological trauma to the patients.

Objective:To assess the effects of preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage on blood loss in complex tibial plateau fractures (Schatzker types Ⅴ-Ⅵ).Methods:A sequence randomly generated by computer was used to randomize a cohort of 40 patients into 2 groups who were to receive surgery at Department of Orthopaedics and Trauma, Hong Hui Hospital from June 2018 to January 2019 for complex tibial plateau fractures. They were 24 men and 16 women, aged from 35 to 55 years (average, 46.0 years). In group A, intravenous injection of normal saline was conducted 5 to 10 min before surgical incision and no elastic bandage was used after surgery. In group B, a dose of 15 mg/kg tranexamic acid was intravenously given 5 to 10 min before surgical incision and elastic bandage was used to bandage the knee with compression after surgery. The 2 groups were compared in terms of total blood loss, hidden blood loss, transfusion rate, 48-h drainage flow, venous thromboembolism, postoperative wound complications, postoperative visual analogue scale (VAS), and D-dimer value 24 h after surgery.Results:There were no significant differences between the 2 groups in age, gender, body mass index, smoking history, concomitant medical conditions, American Society of Anesthesiologists (ASA) score, preoperative hemoglobin, preoperative hematocrit, preoperative D-dimerization or fibrin degradation products, showing comparability ( P>0.05). In groups A and B, hemoglobin values 24 h after surgery were 104.6 g/L ± 10.4 g/L versus 113.3 g/L ± 11.9 g/L, drainage volumes 48 h after surgery 277.1 mL ± 229.2 mL versus 207.1 mL ± 124.3 mL, hidden blood loss volumes 318.0 mL ± 83.4 mL versus 266.2 mL ± 60.9 mL, total blood loss volumes 792.8 mL ± 202.8 mL versus 692.2 mL ± 124.9 mL, D-dimer values 24 h after surgery 5.1 mg/L ± 1.3 mg/L versus 4.1 mg/L ± 0.7 mg/L, postoperative VAS scores 5.2 ± 0.9 versus 3.9 ± 1.1, lower limb cross-section diameters 24 h after surgery 35.5 cm ± 3.0 cm versus 34.4 cm ± 2.6 cm, lower limb cross-section diameters 72 h after surgery 33.8 cm ± 2.1 cm versus 32.8 cm ± 2.3 cm, postoperative rates of wound ecchymosis hematoma 20.0% (4 cases) versus 0 (0 cases), and hospital stays 6.6 d ± 1.0 d versus 6.2 d ± 1.2 d. There were significant differences between the 2 groups in all the above items ( P<0.05). However, there were no significant differences between the 2 groups in incidence of postoperative DVT, pulmonary embolism or other wound complications ( P>0.05). Conclusions:Preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage is reasonable and safe for complex tibial plateau fractures, because it significantly reduces intraoperative blood loss but does not increase the risk of venous thromboembolism, and thus has a positive role in accelerating the recovery of patients.