Numerous techniques for C2 screw fixation have been recently reported. However, concerns remain regarding the risk of spinal cord or vertebral artery injury and inadequate biomechanical stability. To our knowledge, the specific transforaminal “in-out-in” screw fixation technique has not been previously reported. This study aimed to investigate the feasibility and preliminary clinical outcomes of a transforaminal “in-out-in” multi-cortical purchase screw for posterior C2 screw fixation. Between October 2022 and March 2023, 10 patients underwent posterior atlantoaxial internal fixation. All patients had severe hypoplasia of the C2 pedicle on at least one side, precluding the use of standard C2 pedicle screws. A transforaminal “in-out-in” screw was used as an alternative. No spinal cord injury, vascular injury, or other major complications were observed. No implant failure was noted at the final follow-up. In conclusion, the transforaminal “in-out-in” screw may achieve rigid three-column fixation with multiple cortical purchases. It represents a safe and effective alternative for posterior C2 fixation in patients with severely narrow C2 pedicles where traditional pedicle screw placement is not feasible.

Stroke-associated pneumonia(SAP),a frequent complication of stroke,adversely affects clinical outcomes and functional recovery.Identifying SAP risk factors and developing robust predictive models are critical for improving patient management.This article reviews recent research advances in SAP risk factors and risk prediction,emphasizes emerging risk factors-including sarcopenia epidemiology,gut microbiota dysbiosis,and thyroid dysfunction-and novel predictive approaches such as risk stratification scores,neuroimaging,biomarkers,and artificial intelligence.We aim to enhance clinical recognition of SAP to facilitate early intervention,reduce incidence,and optimize stroke prognosis.

The traditional teaching model centered on courses has disadvantages such as interdisciplinary barriers, repetitive learning of content, and students being unable to enter clinical practice early. The Human Body Overview I is a core course at the basic stage under the integrated curriculum system centered on "organ-systems" at Chongqing Medical University. The course deeply integrates interdisciplinary resources and reconstructs the contents of systematic anatomy, embryology, and physiology under the traditional teaching model. The "Three in One" curriculum ideology and politics are implemented to assist students in their comprehensive development. By strengthening the cultivation of clinical application abilities and empowering with virtual simulation technology, the teaching effectiveness and quality have been improved. The teaching practice of the Human Body Overview I suggests that the teaching reform of integrated curriculum at the basic stage has broken interdisciplinary barriers, avoided repetitive learning of contents, and promoted the cultivation of students' interdisciplinary integration ability and clinical application ability. It can provide a reference for the teaching reform of integrated curriculum for other colleges.

Objective In response to the clinical needs for personalized wrist orthoses,a topological optimization design method was proposed to achieve an integrated macro-and micro-structural optimization of a personalized,lightweight,and comfortable wrist orthosis.Methods A composite biomechanical finite element model of the wrist orthosis and upper limb was established to quantify the effects of the orthosis geometry on its fixation performance and comfort.A multi-condition topological optimization and microstructure design approach was employed to optimize the non-load-bearing areas of the orthosis.The orthosis was manufactured using three-dimensional(3D)-printed polyether ether ketone(PEEK),and the feasibility of the design was validated.Results While maintaining mechanical strength,the weight of the 3D-printed PEEK orthosis was reduced by 28％compared to the traditional orthoses.Both the pressure at the skin contact interface and the results of a subjective questionnaire indicated that test subjects experienced a high level of comfort wearing the orthosis.Conclusions The orthosis design achieved personalization,lightweight structure,and high comfort while ensuring mechanical strength and fixation performance.

Objective:To investigate brain damage and treatment efficacy in patients with first-episode schizophrenia with comorbid auditory and visual hallucinations and cognitive decline based on brain magnetic resonance imaging (MRI).Methods:This study adopted a retrospective cohort design. Eighty patients with first-episode schizophrenia who received treatment at Wenzhou Seventh People's Hospital from January to June 2024 were included in this study. The patients were divided into an observation group (40 cases of first-episode schizophrenia with comorbid auditory and visual hallucinations) and a control group (40 cases of first-episode schizophrenia without comorbid auditory and visual hallucinations) based on whether they had symptoms of comorbid auditory and visual hallucinations. Forty healthy individuals who concurrently underwent physical examinations were included in the normal group. All patients received standardized treatment. Cranial MRI data were collected from all subjects. Cranial MRI data, Positive and Negative Syndrome Scale (PANSS) score, Global Assessment of Functioning (GAF) score, and changes in cognitive function were compared among the three groups. Additionally, the changes in cranial MRI data, PANSS score, GAF score, and the score of MATRICS Consensus Cognitive Battery (MCCB) in the observation group were compared between before and after treatment.Results:The horizontal distance between the corpus callosum and the underside of the cingulate gyrus, the vertical distance between the corpus callosum and the underside of the cingulate gyrus, and PANSS and GAF scores in the observation group were all significantly higher than those in the normal and control groups (all P < 0.05). The scores on all MCCB scales in the observation group were significantly lower than those in the normal and control groups (all P < 0.05). After treatment, the left horizontal distance between the corpus callosum and the underside of the cingulate gyrus [(5.72 ± 0.71) mm] and the right horizontal distance [(5.13 ± 0.55) mm], as well as the left vertical distance [(6.37 ± 0.69) mm] and the right vertical distance [(5.61 ± 0.67) mm], were all significantly lower than the pre-treatment values [(6.98 ± 0.83) mm, (6.07 ± 0.49) mm, (7.54 ± 0.58) mm, and (6.52 ± 0.51) mm, t = 7.30, 8.07, 8.21, 6.84, all P < 0.05]. Post-treatment PANSS scores [(39.95 ± 6.65)] were significantly lower than pre-treatment scores [(97.47 ± 18.47)], while post-treatment GAF scores [(71.26 ± 8.87)] were significantly higher than pre-treatment scores [(34.68 ± 7.71), t = 18.53, 19.69, both P < 0.05]. Post-treatment scores for the MCCB [(8.57 ± 2.45), (2.25 ± 0.47), (25.16 ± 2.43), (24.10 ± 2.64), (17.08 ± 2.25), (20.43 ± 3.76), (2.07 ± 0.36), (22.16 ± 3.24), (57.81 ± 7.69), (0.28 ± 0.05)] were significantly higher than pre-treatment scores [(5.65 ± 1.37), (1.62 ± 0.34), (21.21 ± 2.27), (20.27 ± 1.78), (12.16 ± 2.08), (14.56 ± 2.34), (1.71 ± 0.25), (17.92 ± 1.64), (40.29 ± 6.56), (0.21 ± 0.03), t = 6.58, 6.87, 7.51, 7.61, 10.15, 8.38, 5.19, 7.38, 10.96, 7.59, all P < 0.05]. Conclusions:The comorbid auditory and visual hallucinations in patients with first-episode schizophrenia, based on brain MRI findings, are closely related to cognitive decline and brain damage. After treatment, both cognitive function and cranial damage in these patients have considerably improved, which is worthy of clinical consideration.

Objective In response to the clinical needs for personalized wrist orthoses,a topological optimization design method was proposed to achieve an integrated macro-and micro-structural optimization of a personalized,lightweight,and comfortable wrist orthosis.Methods A composite biomechanical finite element model of the wrist orthosis and upper limb was established to quantify the effects of the orthosis geometry on its fixation performance and comfort.A multi-condition topological optimization and microstructure design approach was employed to optimize the non-load-bearing areas of the orthosis.The orthosis was manufactured using three-dimensional(3D)-printed polyether ether ketone(PEEK),and the feasibility of the design was validated.Results While maintaining mechanical strength,the weight of the 3D-printed PEEK orthosis was reduced by 28％compared to the traditional orthoses.Both the pressure at the skin contact interface and the results of a subjective questionnaire indicated that test subjects experienced a high level of comfort wearing the orthosis.Conclusions The orthosis design achieved personalization,lightweight structure,and high comfort while ensuring mechanical strength and fixation performance.

Objective To address the current issues of strong subjectivity in drug classification,vague classification standards,and complex influencing factors,this study aims to explore a scientific method for drug classification to reduce inventory costs and improve inventory effectiveness.Methods A total of 700 drugs were randomly selected from the historical data of a tertiary hospital in Beijing from 2021 to 2022 as the research subjects.The classification was conducted using the Principal Component Analysis(PCA)algorithm and the K-means clustering algorithm(K-means).Results The optimal number of classifications was determined to be 4,with a silhouette coefficient of 0.347 0.The 700 drugs were divided into four categories,with 363 in the first category,186 in the second,94 in the third,and 57 in the fourth.The drug classification method studied in this paper was simulated and applied to the drug inventory management of a certain tertiary hospital in the second quarter of 2023.The simulation results indicated that the classification method studied in this paper could reduce inventory costs and improve inventory effectiveness.Conclusion The drug classification method based on PCA algorithm and K-means clustering algorithm can provide a reliable basis for the management of drug inventory classification.

OBJECTIVE To analyze the clinical data of the immunocompromised patients complicated with Pneumo-cystis jirovecii pneumonia(PJP)and explore the values of G test and lymphocyte subsets in diagnosis of the PJP in the immunocompromised patients.METHODS A total of 78 immunocompromised patients who were treated in respiratory intensive care unit of the First Affiliated Hospital of Shandong First Medical University from Jan.2019 to Dec.2021 wee recruited as the research subjects,39 of whom had PJP and were assigned as the PJP group,39 did not have PJP and were assigned as the non-PJP group.The clinical data were compared between the two groups.The values of the clinical laboratory test indexes in diagnosis of PJP in the immunocompromised patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The mortality rate of the PJP group was higher than that of the non-PJP group(P＜0.05).There were significant differences in the white blood cell(WBC)counts,neutrophils(Neu)counts,platelet distribution width(PDW),procalcitonin(PCT),C-reac-tive protein(CRP)and GM test between the PJP group and the non-PJP group;the G test was(1843.59±1621.41)pg/ml in the PJP group,(87.15±111.01)pg/ml in the non-PJP group;the percentage of CD8 lympho-cyte was(36.22±19.34)％in the PJP group,(25.99±13.10)％in the non-PJP group,and there were significant differences(P＜0.05).The areas under the curves(AUCs)of the G test and the percentage of CD8 lymphocyte were respectively 0.981 and 0.714 in diagnosis of PJP in the immunocompromised patients,and the cutoff values were 368.40 pg/ml and 31.30％,respectively.CONCLUSIONS It is necessary for the clinicians to pay great attention to the high mortality rate of the immunocompromised patients complicated with severe pneumonia.The G test and the percentage of CD8 lymphocyte have certain values in diagnosis of PJP in the immunocompromised patients.

Objective To investigate the effects of Amanita caojizong on cardiomyocyte apoptosis and the expression of apoptosis-related factors Bcl-2 and Bax,thereby providing experimental evidence for the prevention and treatment of Amanita caojizong poisoning.Methods Mouse cardiomyocytes(HL-1 cells)cultured in vitro were divided into an experimental group(treated with Amanita caojizong extract)and a control group(treated with PBS).After treatment with Amanita caojizong extract,apoptosis of HL-1 cells was observed using TUNEL staining,and the protein expression levels of Bax,Bcl-2,Caspase-3,and Cleaved Caspase-3 in HL-1 cardiomyocytes were detected by Western blot.Results Compared with the control group,the TUNEL staining showed significantly increased apoptotic fluorescence intensity in the Amanita caojizong extract-treated group.The protein expressions of Bax,Caspase-3,and Cleaved Caspase-3 in HL-1 cells in the Amanita caojizong-treated group were upregulated,while the expression of Bcl-2 was downregulated.Conclusion Amanita caojizong can promote apoptosis of mouse cardiomyocytes,and its mechanism may be associated with the Bcl-2/Bax pathway.

Objective To establish,evaluate and validate the Nomogram prediction model of radiation pneumonitis(RP)in intensity modulated radiotherapy(IMRT)with TCM syndrome elements.Methods 257 patients with locally advanved non-small cell lung cancer receiving IMRT were analyzed retrospectively.The total population was randomly divided into a training set and a validation set by 7:3.A prediction model was established by Lasso-Logistic regression analysis,and then visualized by Nomogram to evaluate and validate the model.Results Independent risk factors included in the prediction model included tumor stage(OR=6.576;P=0.003),position(OR=2.935;P=0.016),MLD of the affected lung(OR=1.001;P<0.001)and Yin deficiency(OR=3.861;P=0.003).Based on the above factors,the prediction model was constructed and visualized.The C-index of the training set and the validation set were 0.865 and 0.867,respectively.The calibration curves of the two sets had a good fit and had certain clinical usefulness.Conclusion Based on the clinical elements of Chinese and Western medicine,tumor stage,position,lung MLD and Yin deficiency,the model can accurately predict the occurrence of≥grade 2 RP,and provide a reference for clinical screening of high-risk patients and further improvement of treatment plan.