Objective:To analyze the value advantages of multimodal ultrasound in the diagnosis of benign and malignant nodules of 4a grade of nodules of Chinese thyroid imaging reporting and data system (C-TIRADS) of diffuse thyroid nodules. Methods:A total of 227 diffuse thyroid nodules (116 malignant nodules and 111 benign nodules) from 219 patients who admitted to Baoji Hospital Affiliated to Xi'an Medical University between January 2020 to December 2023 were retrospectively selected. Two-dimensional ultrasound and multimodal ultrasound were used to diagnose diffuse thyroid nodules,and to perform data analysis. There were 49 males and 170 females,ranging in age from 24 to 72 years old,whose average age was 52.31±10.08 years. The result of pathological diagnosis was used as the "gold standard",and the results of pathological diagnosis and the parameters of multimodal ultrasound for diffuse thyroid nodules were compared. The diagnostic efficiency of the results of multimodal ultrasound and two-dimensional ultrasound for diffuse thyroid nodules was compared and analyzed. Results:As the results of pathological diagnosis,the scores of contrast-enhanced ultrasound,micro blood flow imaging,elastography and malignant risk score of multimodal ultrasound technique of malignant diffuse thyroid nodules were significantly higher than those of benign nodules (Z=-4.258,-5.007,-5.631,P<0.05),respectively. The sensitivity (92.24％) and specificity (92.79％) of multimodal ultrasound were significantly higher than those (75.00％ and 83.78％) of two-dimensional ultrasound (x2=12.588,4.356,P<0.05),respectively. The positively predictive values (93.04％) and negatively predictive values (91.96％) of multimodal ultrasound were significantly higher than those (82.86％ and 76.23％) of two-dimensional ultrasound (x2=5.465,10.629,P<0.05),respectively. Conclusion:For the judgment of benign and malignant nodules of C-TIRADS 4a in the background of diffuse thyroid nodules,the application of multimodal ultrasound technique,especially the combined use of contrast-enhanced ultrasound,elastography and micro blood flow imaging,can greatly improve the accuracy of ultrasonic diagnosis of these diseases.

Objective:To explore the value of serum P-selectin,Interleukin-18(IL-18),and Homocysteine(Hcy)levels in predicting the adverse outcomes of interventional therapy in elderly patients with deep vein thrombosis(DVT)in the lower extremities.Methods:A total of 165 elderly patients with DVT from January 2020 to August 2023 were se-lected.All patients underwent transcatheter intervention thrombolysis therapy.Patients were divided into good outcome group and poor outcome group according to the clinical treatment outcome.Serum P-selectin,IL-18,and Hcy levels were compared between the two groups.The correlation between serum P-selectin,IL-18,and Hcy levels and disease indicators,as well as the outcomes of interventional therapy was analyzed.The predictive value of serum P-selectin,IL-18,and Hcy levels for the outcomes of interventional therapy was evaluated.Results:The total effective rate of catheter-based interventional thrombolysis in 165 patients was 81.82%(135/165).The patients with good outcomes were included in the good outcome group,and the patients with poor outcomes were included in the poor outcome group.The difference in circumference between the affected side and the healthy side of the thigh and the difference in circumference between the affected side and the healthy side of the calf in the poor outcome group were greater than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy in the poor outcome group were higher than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy were posi-tively correlated with the difference in circumference between the affected and healthy thighs and the difference in cir-cumference between the affected and healthy calves,and negatively correlated with the outcome of interventional therapy(P<0.05).Before and after correcting other factors,serum P-selectin,IL-18,and Hcy were all independent risk factors for the outcome of interventional therapy in elderly patients with DVT(P<0.05).The area under the curve(AUC)of serum P-selectin,IL-18,and Hcy for predicting the outcome of interventional therapy for elderly DVT was 0.789(95%CI:0.718-0.848),0.812(95%CI:0.744-0.868),and 0.792(95%CI:0.722-0.851),respectively.The cutoff values were 44.21 ng/mL,185.73 ng/L,and 23.60 μmol/L,with sensitivities of 70.00%,70.00%,and 80.00%,and specificities of 82.22%,82.96%,and 68.15%,respectively.The AUC of the combined prediction of the outcomes of interventional therapy for elderly DVT was 0.935(95%CI:0.886-0.967),with a cutoff value of 44.08 ng/mL,185.16 ng/L,and 23.37 μmol/L for the three variables,with a sensitivity of 86.67%and a specificity of 88.15%.This was significantly better than the individual prediction values of the three variables(Z=5.817,4.753,5.206,all P<0.001).Conclusion:Serum P-selectin,IL-18,and Hcy are significantly correlated with disease indicators and interventional treatment outcomes in el-derly patients with DVT,and can effectively predict the outcome of interventional treatment,with a high combined pre-dictive value.

Objective To characterize the epidemiological,radiographic and clinical features of transmigrated mandibular canines by cone-beam CT(CBCT),in order to provide assistance for treatment planning.Methods Patients treated at our institution diagnosed with mandibular canines transmigration were retrospectively screened using CBCT images from June 2012 to December 2018.Clinical and radiographic parameters including location,classification,neighbouring structures,and associated anomalies were evaluated.Re-sults Eighty-two patients with 85 transmigrated mandibular canines were enrolled,establishing a prevalence of 0.11％(82/75 021).Among these cases,79 patients had unilateral transmigration of mandibular canines;the other 3 had bilateral transmigrations.Thirty-nine cases were male and 43 were female,with age ranging from 10 to 58.According to the Mupparapu classification,type Ⅰ(42,49.41％)was the most prevalent followed by type Ⅱ(19,22.35％)and type Ⅲ(15,17.65％).Fifty-three(62.35％)crowns were located labially,and often associated with odontoma,cyst and supernumerary tooth.Seventy transmigrated canines were surgically re-moved while 2 cases were tried to orthodontically aligned,failed and finally extracted.Ten cases received routine monitoring.Conclu-sion The transmigration of mandibular canines is rarely occurring abnormality with certain clinical imaging features which can assist in clinical diagnosis and treatment planning.

Objective To explore the short and long term efficacy of ultrasound therapy combined with muscle imbalance adjustment training in patients with adhesive capsulitis(AC) ofthe shoulder. Methods A total of 60 AC patients were divided into an observation group and a control group,both each consisting of 30 cases. The observation group underwentultrasound therapy along with muscle imbalance adjustment training,while the control group received acupuncture treatment,both for a duration of 20 days. The Visual Analogue Scale(VAS),goniom-eter for ROM,Manual Muscle Testing(MMT),Constant-Murley Shoulder Score,and modified Barthel index were used to access shoulder jointpain level,range of motion (ROM),peripheral muscle strength,shoulder joint func-tion,and daily living abilities,respectively. The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were utilized to evaluate the levels of anxiety and depression.All the assessments were conducted and compared between the two groups before treatment,at the end of treatment,and at 6 and 12 months after treatment. Results Both groups showed varying degrees of improvement in ROM,MMT,VAS,Constant-Murley score,modified Barthel index,and emotional status compared to pre-treatment. The observation group demonstrated superior outcomes in posterior shoulder extension strength,VAS,Constant-Murley score,modified Barthel index,HAMA,and HAMD scores at the end of treatment (P<0.05). At 6 months post-treatment,the observation group showed better shoulder joint flexion,extension,abduction,and adduction ROM,as well as muscle strength in flexion,external rotation,and internal rotation,VAS,Constant-Murley score,modified Barthel index,HAMA,and HAMD scores. At 12 months after treatment,the observation group continued to show superior outcomes in all the aforementioned indexes (P<0.05). Conclusion The combination of ultrasound therapy and muscle imbalance adjustment training can effectively reduce shoulder joint pain,improve ROM,enhance muscle strength around the shoulder joint,improve shoulder joint function,alleviate anxiety and depression,and ultimately enhance the quality of life for patients with AC.

Objective:To analyze the value advantages of multimodal ultrasound in the diagnosis of benign and malignant nodules of 4a grade of nodules of Chinese thyroid imaging reporting and data system (C-TIRADS) of diffuse thyroid nodules. Methods:A total of 227 diffuse thyroid nodules (116 malignant nodules and 111 benign nodules) from 219 patients who admitted to Baoji Hospital Affiliated to Xi'an Medical University between January 2020 to December 2023 were retrospectively selected. Two-dimensional ultrasound and multimodal ultrasound were used to diagnose diffuse thyroid nodules,and to perform data analysis. There were 49 males and 170 females,ranging in age from 24 to 72 years old,whose average age was 52.31±10.08 years. The result of pathological diagnosis was used as the "gold standard",and the results of pathological diagnosis and the parameters of multimodal ultrasound for diffuse thyroid nodules were compared. The diagnostic efficiency of the results of multimodal ultrasound and two-dimensional ultrasound for diffuse thyroid nodules was compared and analyzed. Results:As the results of pathological diagnosis,the scores of contrast-enhanced ultrasound,micro blood flow imaging,elastography and malignant risk score of multimodal ultrasound technique of malignant diffuse thyroid nodules were significantly higher than those of benign nodules (Z=-4.258,-5.007,-5.631,P<0.05),respectively. The sensitivity (92.24％) and specificity (92.79％) of multimodal ultrasound were significantly higher than those (75.00％ and 83.78％) of two-dimensional ultrasound (x2=12.588,4.356,P<0.05),respectively. The positively predictive values (93.04％) and negatively predictive values (91.96％) of multimodal ultrasound were significantly higher than those (82.86％ and 76.23％) of two-dimensional ultrasound (x2=5.465,10.629,P<0.05),respectively. Conclusion:For the judgment of benign and malignant nodules of C-TIRADS 4a in the background of diffuse thyroid nodules,the application of multimodal ultrasound technique,especially the combined use of contrast-enhanced ultrasound,elastography and micro blood flow imaging,can greatly improve the accuracy of ultrasonic diagnosis of these diseases.

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia(RMPP),precisely identify the joint predictors in these children,and construct a prediction model.This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies.Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1,2023,and February 29,2024.Among these children,119 with RMPP were classified into the RMPP group,while the remaining 163 with general MPP(GMPP)were assigned to the GMPP group.The clinical data of both groups,encompassing age,gender,duration of fever,symptoms,laboratory test indices,chest imaging data,complications,etc.,were compared.A logistic probability model(LogP model)for joint application was constructed.The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic(ROC)curve,and the calibration of the model was assessed by means of a calibration curve.Results In comparison with the GMPP group,children in the RMPP group exhibited a significantly longer duration of fever(P=0.002).Moreover,they had a higher incidence of complications,including myocardial damage and coagulation dysfunction(P<0.05).Regarding inflammatory markers,the levels of C-reactive protein(CRP),procalcitonin(PCT),and lactate dehydrogenase(LDH)were notably elevated in the RMPP group(P<0.05),whereas the level of albumin(Alb)was lower(P=0.001).In the RMPP group,the levels of interleukin-2(IL-2),interleukin-5(IL-5),interleukin-8(IL-8),interleukin-1β(IL-1β),and D-Dimer were increased,while the levels of interleukin-6(IL-6)and interleukin-17(IL-17)were decreased(P<0.05).Chest computed tomography(CT)scans revealed a higher proportion of lung consolidation,pleural effusion,and atelectasis in the RMPP group(P<0.05).Multivariate logistic regression analysis demonstrated that CRP,total bilirubin(T-BIL),LDH,IL-17,and prothrombin time(PT)were independent risk factors for RMPP(P<0.05).The receiver operating characteristic(ROC)predictive model established based on these factors had an area under the curve(AUC)of 0.787(95%confidence interval[CI]:0.693～0.880),with a cutoff value of 0.421,a sensitivity of 0.786,and a specificity of 0.660.The calibration curve indicated that the predicted probability matched well with the reference probability,and there was no statistical difference in the results of the Hosmer-Lemeshow test(P>0.05).Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever,moderate lung lesions,other organ injuries,and high inflammatory markers.CRP,T-BIL,LDH,IL-17,and PT can act as independent risk factors for RMPP.

As population aging intensifies,stroke incidence is rising yearly.Complicated with neurological impairment,this condition often leads to motor dysfunction,affecting walking stability and coordination and severely impacting the patient's daily life and mental state.In recent years,digital technology-assisted walking rehabilitation training has shown great potential in post-stroke rehabilitation.By integrating modern digital technolo-gies such as virtual reality,intelligent feedback systems,and remote rehabilitation,this approach not only provides personalized rehabilitation plans but also promotes the recovery of walking function through immersive training,real-time feedback,and remote monitoring.This article reviews the application status,effectiveness,and limita-tions of digital-technology-assisted walking rehabilitation for post-stroke hemiplegic patients.It aims to clarify the new direction of post-stroke walking training and explore more effective rehabilitation methods to help patients regain their walking ability.

Objective:To investigate the correlation between vasoactive-inotropic score and 30-day mortality after surgery in acute Stanford type A aortic dissection(ATAAD) patients.Methods:The clinical data of 242 patients with ATAAD who underwent surgical treatment was retrospectively analyzed between November 2015 and May 2024. There were 172 males and 70 females. The average age was(53.1±11.9) years, ranging from 28 to 85 years. Patients were divided into death group(18 cases) and survival group(224 cases) according to the 30-day outcomes after surgery. The VIS at different time points and perioperative indexes of two groups of patients were analyzed, and multivariate logistic regression was used to analyze the risk factors of 30-day mortality after surgery in ATAAD patients. The receiver operating characteristic curve( ROC) was drawn to evaluate the predictive value of vasoactive-inotropic score. Results:Among 242 ATAAD patients, 18 patients died within 30 days after surgery, with a mortality rate of 7.4%. The age, incidence of pericardial tamponade/cardiogenic shock, incidence of malperfusion syndrome, cardiopulmonary bypass time, red blood cell transfusion intraoperative and in 24 hours postoperatively, ventilator assisted time, and incidence of major postoperative complications of patients in the death group were significantly higher than those in the survival group( P<0.05). The VIS of the death group was significantly higher than that of the survival group at all time points( P<0.05). The area under the receiver operating characteristic curve( AUC) of VIS for predicting death at each time point was greater than 0.500( P<0.05), with the highest AUC(0.906) of the second 24 hours(VISmax48h) in ICU. The optimal cut off value was determined to be 9, with a sensitivity of 0.944 and a specificity of 0.821. Logistic regression analysis showed that the VISmax48h of the second 24 hours in ICU was an independent risk factor for 30-day mortality after surgery in ATAAD patients( OR=1.462, 95% CI: 1.230-1.737, P<0.05). Conclusion:When VISmax48h≥9, patients with ATAAD have an increased risk of mortality after surgery. VISmax48h, cardiopulmonary bypass time, and red blood cell transfusion intraoperative in 24 hours postoperatively are independent risk factors for the 30-day mortality of ATAAD patients.

OBJECTIVE: In Pakistan, traditional medicines are an important component of the medical system, with numerous varieties and great demands. However, due to the scattered resources and the lack of systematic collection and collation, adulteration of traditional Pakistani medicine (TPM) is common, which severely affects the safety of their medicinal use and the import and export trades. Therefore, it is urgent to systematically organize and unify the management of TPM and establish a set of standards and operable methods for the identification of TPM. METHODS: We collected and organized the information on 128 TPMs with regard to their medicinal parts, efficacy, usage, and genetic material, based on Pakistan Hamdard Pharmacopoeia of Eastern Medicine: Pharmaceutical Codex. The genetic information of TPM is summarized from national center for biotechnology information (NCBI) and global pharmacopoeia genome database (GPGD). Furthermore, we utilized bioinformatics technology to supplement the chloroplast genome (cp-genome) data of 12 TPMs. To build the web server, we used the Linux + Apache + MySQL + PHP (LAMP) system and constructed the webpage on a PHP: Hypertext Preprocessor (PHP) model view controller (MVC) framework. RESULTS: We constructed a new genomic database, the traditional Pakistani medicine genomic database (TPMGD). This database comprises five entries, namely homepage, medicinal species, species identification, basic local alignment search tool (BLAST), and download. Currently, TPMGD contains basic profiles of 128 TPMs and genetic information of 102 TPMs, including 140 cytochrome c oxidase subunit I (COI) sequences and 119 mitochondrial genome sequences from Bombyx mori, 1 396 internal transcribed spacer 2 (ITS2) sequences and 1 074 intergenic region (psbA-trnH) sequences specific to 92 and 83 plant species, respectively. Additionally, TPMGD includes 199 cp-genome sequences of 82 TPMs. CONCLUSION TPMGD is a multifunctional database that integrates species description, functional information inquiry, genetic information storage, molecular identification of TPM, etc. The database not only provides convenience for TPM information queries but also establishes the scientific basis for the medication safety, species identification, and resource protection of TPM.

Objective To characterize the epidemiological,radiographic and clinical features of transmigrated mandibular canines by cone-beam CT(CBCT),in order to provide assistance for treatment planning.Methods Patients treated at our institution diagnosed with mandibular canines transmigration were retrospectively screened using CBCT images from June 2012 to December 2018.Clinical and radiographic parameters including location,classification,neighbouring structures,and associated anomalies were evaluated.Re-sults Eighty-two patients with 85 transmigrated mandibular canines were enrolled,establishing a prevalence of 0.11％(82/75 021).Among these cases,79 patients had unilateral transmigration of mandibular canines;the other 3 had bilateral transmigrations.Thirty-nine cases were male and 43 were female,with age ranging from 10 to 58.According to the Mupparapu classification,type Ⅰ(42,49.41％)was the most prevalent followed by type Ⅱ(19,22.35％)and type Ⅲ(15,17.65％).Fifty-three(62.35％)crowns were located labially,and often associated with odontoma,cyst and supernumerary tooth.Seventy transmigrated canines were surgically re-moved while 2 cases were tried to orthodontically aligned,failed and finally extracted.Ten cases received routine monitoring.Conclu-sion The transmigration of mandibular canines is rarely occurring abnormality with certain clinical imaging features which can assist in clinical diagnosis and treatment planning.