Objective:To explore the application effects of a four-in-one blended teaching model integrating artificial intelligence, virtual reality, 3D printing, and case-based learning (CBL) in the clinical teaching of spinal tumors.Methods:We divided 89 students on training in the Department of Orthopedics of Peking University Third Hospital from September 2022 to August 2024 into control group ( n=47) and experimental group ( n=42). The control group adopted traditional teaching, and the experimental group adopted the four-in-one teaching model. At the end of clinical teaching, an artificial intelligence test and a questionnaire survey were administered to the students to evaluate the teaching effects. The two groups were compared using the independent samples t-test with the use of SPSS 27.0. Results:The experimental group was superior to the control group with significant improvements in the answer accuracy rate (66.67%, χ2=9.44, P=0.002), learning interest [(4.50±0.63), t=2.75, P=0.007], theoretical knowledge mastery [(4.64±0.69), t=7.74, P<0.001], clinical thinking [(4.48±0.71), t=9.08, P<0.001], practical skills [(4.13±0.89), t=2.69, P=0.009], scientific research innovation [(4.71±0.59), t=9.28, P<0.001], teacher-student interaction [(4.74±0.54), t=12.76, P<0.001], and classroom attention [(4.69±0.52), t=12.64, P<0.001]. At the same time, the students in the experimental group put forward numerous constructive feedback. Conclusions:The four-in-one blended teaching model combining artificial intelligence, virtual reality, 3D printing, and CBL can help undergraduate medical students better recognize and diagnose spinal tumors with a correct clinical thinking path, achieving good teaching effects.

Pyoderma gangrenosum(PG)is a rare autoinflammatory disease,characterized mainly by painful and necrotic skin ulcers.The etiology of PG is unknown,and its treatment is quite challenging.This article reports a case of recurrent pyoderma gangrenosum successfully treated with adalimumab combined with tofacitinib,along with a review of relevant literature.The patient,a 54-year-old male,presented with scrotal ulcers accompanied by pain for 20 days,worsening and involving the groin area for 5 days,and fever for 1 day.Dermatological examination revealed two painful ulcers on the scrotum with raised edges,clear boundaries,and a small amount of purulent discharge on the surface;the right groin area and the medial left thigh showed irregular infiltrative erythematous plaques,with scattered clustered pustules on them,central necrosis appearing purplish-brown,surrounded by a red halo with clear boundaries.Based on the patient's past medical history,clinical manifestations,and auxiliary examinations,the diagnosis was consistent with pyoderma gangrenosum.After treatment with adalimumab combined with tofacitinib,the patient's symptoms were significantly improved,and the ulcers healed.At the 6-month follow-up,the skin lesions had not recurred.For refractory PG that is ineffective to conventional treatments,adalimumab combined with tofacitinib is an effective and safe treatment option,providing a new combination therapy regimen for PG.

Objective To explore the relationship between levels of vascular endothelial growth factor(VEGF),insulin-like growth factor 1(IGF-1),and transforming growth factor-β1(TGF-β1)in the synovial fluid of children with avascular necrosis of the femoral head(also known as Perthes disease)and the efficacy of postoperative revascularization,aiming to provide a basis for subsequent diagnosis and treatment.Methods A retrospective study was conducted on 262 children with Perthes disease admitted to the Affiliated Hospital of Gansu University of Chinese Medicine from January 2023 to June 2024.Based on postoperative revascularization efficacy,patients were divided into good revascularization group(n=228)and poor revascularization group(n=34).For poor revascularization group,a 1:2 matched case-control design was used to select 68 age-matched children with hip synovitis who underwent hip joint fluid puncture as control group.Additionally,82 children with Perthes disease treated at the hospital from June 2024 to January 2025 were enrolled as a validation cohort for nomogram model verification.The expression levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of three groups were compared.Confounding biases were controlled through univariate and stratified analyses.Binary logistic regression analysis was used to identify independent factors affecting the revascularization effect.R software was utilized to draw and verify the nomogram model for predicting the postoperative revascularization effect.Results The levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of children in poor revascularization group were all higher than those in control group and good revascularization group(P<0.05).After three types of reconstructive surgeries,the levels of VEGF,IGF-1 and TGF-β1 in the synovial fluid of children with poor revascularization were all higher than those in children with good revascularization(P<0.05);however,there was no statistically significant difference in the above indicators among different surgical types(P>0.05).Binary logistic regression analysis showed that the levels of VEGF,IGF-1,and TGF-β1 in the synovial fluid were independent risk factors for poor postoperative revascularization in children with Perthes disease.The area under the ROC curve of the nomogram model established accordingly for predicting poor postoperative revascularization in children with Perthes disease was 0.875(95%CI 0.805-0.945),with a sensitivity of 0.874 and a specificity of 0.851.Moreover,the calibration curve and decision curve analysis(DCA)indicated that the model had good clinical applicability.Conclusions The increased levels of VEGF,IGF-1 and TGF-β1 in synovial fluid are associated with poor postoperative revascularization in children with Perthes disease.These three factors are expected to become prognostic indicators for children with Perthes disease.

Objective:To explore the application effects of a four-in-one blended teaching model integrating artificial intelligence, virtual reality, 3D printing, and case-based learning (CBL) in the clinical teaching of spinal tumors.Methods:We divided 89 students on training in the Department of Orthopedics of Peking University Third Hospital from September 2022 to August 2024 into control group ( n=47) and experimental group ( n=42). The control group adopted traditional teaching, and the experimental group adopted the four-in-one teaching model. At the end of clinical teaching, an artificial intelligence test and a questionnaire survey were administered to the students to evaluate the teaching effects. The two groups were compared using the independent samples t-test with the use of SPSS 27.0. Results:The experimental group was superior to the control group with significant improvements in the answer accuracy rate (66.67%, χ2=9.44, P=0.002), learning interest [(4.50±0.63), t=2.75, P=0.007], theoretical knowledge mastery [(4.64±0.69), t=7.74, P<0.001], clinical thinking [(4.48±0.71), t=9.08, P<0.001], practical skills [(4.13±0.89), t=2.69, P=0.009], scientific research innovation [(4.71±0.59), t=9.28, P<0.001], teacher-student interaction [(4.74±0.54), t=12.76, P<0.001], and classroom attention [(4.69±0.52), t=12.64, P<0.001]. At the same time, the students in the experimental group put forward numerous constructive feedback. Conclusions:The four-in-one blended teaching model combining artificial intelligence, virtual reality, 3D printing, and CBL can help undergraduate medical students better recognize and diagnose spinal tumors with a correct clinical thinking path, achieving good teaching effects.

Objective To investigate risk factors of medication non-adherence in elderly patients with hypertension through Meta-analysis.Methods Literatures on medication non-adherence in elderly patients with hypertension were systematically reviewed across various databases,from inception to September 1st 2023,including CNKI,VIP,Wangfong Database,SinoMed,PubMed,Web of Science,Cochrane Library、EMbase.Meta-analysis was conducted using RevMan 5.4.Results A total of 19 articles were included,comprising a total of 18 220 patients in sample size.Meta analysis identified 10 risk factors,showed significant association(P<0.05)with:age[OR=1.36,95%CI=(1.00,1.86)],place of residence[OR=1.91,95%CI=(1.33,2.75)],method of payment for medical expenses[OR=1.60,95%CI=(1.38,1.86)],income level[OR=1.68,95%CI=(1.45,1.95)],occupational status[OR=1.79,95%CI=(1.37,2.36)],social support[OR=1.43,95%CI=(1.27,1.60)],comorbidity[CI=0.33,95%(0.19,0.58)],frequency of blood pressure measurement[CI=1.53,95%(1.14,2.05)],disease awareness[OR=1.70,95%CI=(1.44,2.00)]and dedication frequency[OR=1.44,95%CI=(1.16,1.79)].In addition,the number of influencing factors such as gender,marital status,depression,cognitive impairment,and complications was included in<3 articles,and only descriptive analysis was conducted.Conclusion Healthcare providers should focus on the identification and management of the risk factors associated with medication non-adherence in elderly patients with hypertension,therefore to reduce the incidence of medication non-adherence.

Objective:To investigate the clinical characteristics and survival prognosis of patients with triple/quad-class exposed relapsed or refractory multiple myeloma(RRMM).Methods:The clinical data of patients with triple/quad-class exposed RRMM from eight centers in Shanxi Province between May 2017 and May 2024 were retrospectively analyzed.Overall survival(OS)and progression-free survival(PFS)were analyzed using the Kaplan-Meier method,and factors affecting survival were examined by the Cox proportional hazards model and Log-rank test.Results:Among the 112 patients with triple-class exposure,16 were quadruple-class exposed.The detection rates of high-risk cytogenetic abnormalities and extramedullary lesions in patients with triple-class exposure were 57.1%and 36.6%,respectively,while those in patients with quadruple-class exposure were 87.5%and 62.5%,respectively.The median PFS and OS of patients with triple-class expos-ure were 5.6 months and 12.2 months,respectively,while those of patients with quadruple-class exposure were 9.4 months and 16.9 months,respectively.Cox model analysis showed that extramedullary lesions and multi-line treatment(≥3 lines)were independent risk factors for the survival of patients with triple-class exposed RRMM(P<0.05).Previous autologous stem cell transplantation,subsequent con-ventional drug treatment,and B-cell maturation antigen(BCMA)chimeric antigen receptor T-cell(CAR-T)treatment were protective factors(P<0.05).After triple-class drug resistance,the Log-rank test verified that BCMA CAR-T treatment significantly prolonged the median PFS of patients compared to conventional drug treatment(9.4 months vs.5.2 months,P=0.026 9),whereas the difference in OS was not statistic-ally significant(16.9 months vs.7.9 months,P=0.263 4).Conclusions:Patients with triple/quad-class exposed RRMM have a poor prognosis,and BCMA CAR-T cell therapy can improve survival in patients with triple-class drug-resistant RRMM.

In order to detect the environmental data of isolated cabin under various environmental conditions,a negative pressure cabin environment detector for aviation was developed,which was composed of a shell,a differential pressure transmitter,a pressure sensor,a carbon dioxide concentration sensor,an oxygen concentration sensor,a temperature and humidity sensor,a data processing module,a liquid crystal display(LCD)screen and USB data interface.It could environmental data such as carbon dioxide concentration,oxygen concentration,temperature,humidity,pressure difference between cabin and outside the cabin and air pressure outside the cabin in real time,the data processing module collected and processed the data,the data and data change curves was displayed in real time by the LCD screen,and the detection data was extracted through the USB data interface.When used in aviation environment,the detector could work continuously without fault for no less than 300 hours,and the average fault repair time was about 30 minutes,with good performance and high detection accuracy,which can provide convenience for the environmental data detection of negative pressure cabins,and is worthy of popularization.

Objective:To investigate the clinical characteristics and survival prognosis of patients with triple/quad-class exposed relapsed or refractory multiple myeloma(RRMM).Methods:The clinical data of patients with triple/quad-class exposed RRMM from eight centers in Shanxi Province between May 2017 and May 2024 were retrospectively analyzed.Overall survival(OS)and progression-free survival(PFS)were analyzed using the Kaplan-Meier method,and factors affecting survival were examined by the Cox proportional hazards model and Log-rank test.Results:Among the 112 patients with triple-class exposure,16 were quadruple-class exposed.The detection rates of high-risk cytogenetic abnormalities and extramedullary lesions in patients with triple-class exposure were 57.1%and 36.6%,respectively,while those in patients with quadruple-class exposure were 87.5%and 62.5%,respectively.The median PFS and OS of patients with triple-class expos-ure were 5.6 months and 12.2 months,respectively,while those of patients with quadruple-class exposure were 9.4 months and 16.9 months,respectively.Cox model analysis showed that extramedullary lesions and multi-line treatment(≥3 lines)were independent risk factors for the survival of patients with triple-class exposed RRMM(P<0.05).Previous autologous stem cell transplantation,subsequent con-ventional drug treatment,and B-cell maturation antigen(BCMA)chimeric antigen receptor T-cell(CAR-T)treatment were protective factors(P<0.05).After triple-class drug resistance,the Log-rank test verified that BCMA CAR-T treatment significantly prolonged the median PFS of patients compared to conventional drug treatment(9.4 months vs.5.2 months,P=0.026 9),whereas the difference in OS was not statistic-ally significant(16.9 months vs.7.9 months,P=0.263 4).Conclusions:Patients with triple/quad-class exposed RRMM have a poor prognosis,and BCMA CAR-T cell therapy can improve survival in patients with triple-class drug-resistant RRMM.

The clinical manifestations of subacute combined degeneration of spinal cord (SCD) in children are complex and vary greatly. Due to the fact that some patients with SCD may be complicated with autoimmune diseases, the high early misdiagnosis and missed diagnosis rates are observed. One case of 13-year old female with severe anemia, multiple joint swelling and pain in left limbs and paralysis of bilateral lower limbs with the extremely low level of serum vitamin B12 and poly-glandular involvement as well as a variety of positive auto-antibodies (anti-intrinsic factor antibody, anti-parietal cell antibody, thyroid peroxidase antibody, thyroid globulin antibody and perinuclear anti-neutrophil cytoplasmic antibody) was retrospectively analyzed. The patient was diagnosed as SCD with autoimmune disease (undifferentiated connective tissue disease and autoimmune polyglandular syndrome). The patient′s condition gradually alleviated after high-dose intravenous methylprednisolone, immunoglobulin, naproxen (then changed to hydroxychloroquine 1 month later), vitamin B12 and levothyroxine sodium tablets supplementation, blood transfusion and rehabilitation. SCD with autoimmune diseases is rare in children, and the clinical manifestations vary greatly. Early recognition and early treatment can improve the prognosis of SCD. The clinical data of this child were retrospectively analyzed, so as to improve the understanding of the disease by clinicians.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.