Objective:To compare the efficacy of Ilizarov ring external fixation and unilateral rail external fixation in the treatment of infected bone defects following surgery for tibial fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 50 patients with infected bone defects after surgery for tibial fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from August 2019 to November 2021, including 37 males and 13 females, aged 19-59 years [(42.2±8.8)years]. After debridement and osteotomy, 28 patients were treated with Ilizarov ring external fixation (Ilizarov group) and 22 with unilateral rail external fixation (unilateral fixation group). All the patients in the two groups had previously undergone internal fixation with plates or Kirschner wires for tibial fracture before bone transport. Bone transport started at one week for three stages after successful infection control and osteotomy and was conducted. The following parameters were compared between the two groups: frame-wearing time and healing index after bone transport, self-rating anxiety scale (SAS) grade at 6 months after bone transport, Paley score and Association for the Study and Application of the Method of Ilizarov (ASAMI) score at the last follow-up, Hospital for Special Surgery (HSS) knee score and Baird-Jackson ankle score on admission, after external fixator removal and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 28-36 months [(32.5±1.6)months]. There were no significant differences in frame-wearing time or healing index between the two groups after bone transport ( P>0.05). At 6 months after bone transport, the SAS grade in the unilateral fixation group (13 patients with mild anxiety, 8 with moderate anxiety, and 1 with severe anxiety) was better than that in the Ilizarov group (6 patients with mild anxiety, 19 with moderate anxiety, 3 with severe anxiety) ( P<0.01). No significant differences were found in the Paley score or ASAMI score between the two groups at the last follow-up ( P>0.05). There were no significant differences in HSS knee score or Baird-Jackson ankle score between the two groups on admission, after external fixator removal or at the last follow-up ( P>0.05). No significant differences were observed in the incidence of pin tract infection, poor healing, infection in the bone elongation area, or re-fracture between the two groups ( P>0.05). The incidence of postoperative axial deviation was 0 in the Ilizarov group, lower than 18% in the unilateral fixation group (4/22) ( P<0.05). Conclusion:Although Ilizarov ring external fixation and unilateral rail external fixation demonstrate comparable efficacy in the treatment of infected bone defects after surgery for tibial fractures, the former provides superior mechanical stability and postoperative axial deviation correction, while the latter offers advantages in reducing psychological burden and enhancing treatment tolerance.

Clamshell incision is widely used in the surgical resection of complex mediastinal tumors, but it is also controversial. Its advantages are the full exposure of the field of vision and the huge operating space, while its disadvantages are the destruction of chest wall muscles and respiratory function impairment. At present, there is a lack of norms for the selection and application of Clamshell incisions, and the definition of complex mediastinal tumors is ambiguous and the dimensions are single. Therefore, this article reviews the literature and combines practical experience to systematically summarize the application progress of Clamshell incisions in the surgical resection of complex mediastinal tumors, with the aim of providing guidance for clinical work.

Objective:To analyze the effect of dapagliflozin tablet combined with creatine phosphate sodium on blood glucose and cardiac function in patients with type 2 diabetes mellitus (T2DM) complicated with heart failure.Methods:A total of 80 patients with T2DM complicated with heart failure who received treatment in the Rehabilitation University Qingdao Hospital (Qingdao Municipal Hospital) from October 2021 to October 2022 were selected prospectively as the subjects, and they were randomly divided into two groups with 40 cases in each group by envelope method. The control group was treated with conventional methods, and the observation group was treated with dapagliflozin tablet combined with sodium creatine phosphate on the basis of conventional methods. Both groups completed the treatment for 3 months. The clinical efficacy, blood glucose control effect, cardiac function and serum indexes of the two groups were compared between the two groups.Results:The total effective rate in the observation group was higher than that in the control group: 95.00%(38/40) vs. 75.00%(30/40), there was statistical difference ( χ2 = 6.28, P<0.05). After treatment, the levels of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin in the observation group were lower than those in the control group: (6.98 ± 0.67) mmol/L vs. (7.81 ± 0.78) mmol/L, (7.87 ± 1.58) mmol/L vs. (9.58 ± 1.49) mmol/L, (6.95 ± 0.57)% vs. (7.41 ± 0.60)%, there were statistical differences ( P<0.05). After treatment, the levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), serum interleukin6 (IL-6), C-reactive protein (CRP) and brain natriuretic peptide (BNP) in the observation group were lower than those in the control group: (61.76 ± 3.55) mm vs. (64.01 ± 3.87) mm, (45.45 ± 3.58) mm vs. (47.71 ± 3.62) mm, (8.99 ± 0.95) ng/L vs.(10.28 ± 1.16) ng/L, (4.28 ± 1.17) mg/L vs. (5.57 ± 1.31) mg/L, (199.90 ± 34.12) ng/L vs. (250.73 ± 35.11) ng/L; the cardiac output (CO) and left ventricular ejection fraction (LVEF) in the observation group were higher than those in the control group: (4.95 ± 1.06) L/min vs. (4.13 ± 0.92) L/min, (44.51 ± 3.68)% vs. (42.15 ± 3.73)%, there were statistical differences ( P<0.05). Conclusions:Dapagliflozin tablets combined with creatine phosphate sodium can improve the effective rate of patients with T2DM complicated with heart failure, reduce the level of blood sugar, help to improve the heart function, and reduce the levels of serum inflammatory factors.

The conventional identification and prediction for failures of medical equipment mainly depend on experience and knowledge of manager for equipment,which are not able to be quantified and have lower efficiency. Therefore,it is obvious that the prediction for the failure of medical equipment is not accurate. With the technical development of computer and machine learning,the conventional identification and prediction that depend on experiences can deal with characteristics of failures through machine learning method to improve efficiency,which are hopeful in filling the gap of discipline about the identification and prediction for failures of medical equipment. This article summarized the application situation of machine learning in identifying and predicting failures of the medical equipment and the similarly electric equipment at home and abroad. Based on the key technique of identification and prediction,this article proposed suggestion about corresponding design architecture. According to the characteristics of the failure of medical equipment,this article summarized a series of information about algorithms of various machine learning in scene and accurate rate of identification and prediction,so as to provide references for relevant research of this field.

The conventional identification and prediction for failures of medical equipment mainly depend on experience and knowledge of manager for equipment,which are not able to be quantified and have lower efficiency. Therefore,it is obvious that the prediction for the failure of medical equipment is not accurate. With the technical development of computer and machine learning,the conventional identification and prediction that depend on experiences can deal with characteristics of failures through machine learning method to improve efficiency,which are hopeful in filling the gap of discipline about the identification and prediction for failures of medical equipment. This article summarized the application situation of machine learning in identifying and predicting failures of the medical equipment and the similarly electric equipment at home and abroad. Based on the key technique of identification and prediction,this article proposed suggestion about corresponding design architecture. According to the characteristics of the failure of medical equipment,this article summarized a series of information about algorithms of various machine learning in scene and accurate rate of identification and prediction,so as to provide references for relevant research of this field.

Objective:To analyze the effect of dapagliflozin tablet combined with creatine phosphate sodium on blood glucose and cardiac function in patients with type 2 diabetes mellitus (T2DM) complicated with heart failure.Methods:A total of 80 patients with T2DM complicated with heart failure who received treatment in the Rehabilitation University Qingdao Hospital (Qingdao Municipal Hospital) from October 2021 to October 2022 were selected prospectively as the subjects, and they were randomly divided into two groups with 40 cases in each group by envelope method. The control group was treated with conventional methods, and the observation group was treated with dapagliflozin tablet combined with sodium creatine phosphate on the basis of conventional methods. Both groups completed the treatment for 3 months. The clinical efficacy, blood glucose control effect, cardiac function and serum indexes of the two groups were compared between the two groups.Results:The total effective rate in the observation group was higher than that in the control group: 95.00%(38/40) vs. 75.00%(30/40), there was statistical difference ( χ2 = 6.28, P<0.05). After treatment, the levels of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin in the observation group were lower than those in the control group: (6.98 ± 0.67) mmol/L vs. (7.81 ± 0.78) mmol/L, (7.87 ± 1.58) mmol/L vs. (9.58 ± 1.49) mmol/L, (6.95 ± 0.57)% vs. (7.41 ± 0.60)%, there were statistical differences ( P<0.05). After treatment, the levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), serum interleukin6 (IL-6), C-reactive protein (CRP) and brain natriuretic peptide (BNP) in the observation group were lower than those in the control group: (61.76 ± 3.55) mm vs. (64.01 ± 3.87) mm, (45.45 ± 3.58) mm vs. (47.71 ± 3.62) mm, (8.99 ± 0.95) ng/L vs.(10.28 ± 1.16) ng/L, (4.28 ± 1.17) mg/L vs. (5.57 ± 1.31) mg/L, (199.90 ± 34.12) ng/L vs. (250.73 ± 35.11) ng/L; the cardiac output (CO) and left ventricular ejection fraction (LVEF) in the observation group were higher than those in the control group: (4.95 ± 1.06) L/min vs. (4.13 ± 0.92) L/min, (44.51 ± 3.68)% vs. (42.15 ± 3.73)%, there were statistical differences ( P<0.05). Conclusions:Dapagliflozin tablets combined with creatine phosphate sodium can improve the effective rate of patients with T2DM complicated with heart failure, reduce the level of blood sugar, help to improve the heart function, and reduce the levels of serum inflammatory factors.

Objective:To compare the efficacy of Ilizarov ring external fixation and unilateral rail external fixation in the treatment of infected bone defects following surgery for tibial fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 50 patients with infected bone defects after surgery for tibial fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from August 2019 to November 2021, including 37 males and 13 females, aged 19-59 years [(42.2±8.8)years]. After debridement and osteotomy, 28 patients were treated with Ilizarov ring external fixation (Ilizarov group) and 22 with unilateral rail external fixation (unilateral fixation group). All the patients in the two groups had previously undergone internal fixation with plates or Kirschner wires for tibial fracture before bone transport. Bone transport started at one week for three stages after successful infection control and osteotomy and was conducted. The following parameters were compared between the two groups: frame-wearing time and healing index after bone transport, self-rating anxiety scale (SAS) grade at 6 months after bone transport, Paley score and Association for the Study and Application of the Method of Ilizarov (ASAMI) score at the last follow-up, Hospital for Special Surgery (HSS) knee score and Baird-Jackson ankle score on admission, after external fixator removal and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 28-36 months [(32.5±1.6)months]. There were no significant differences in frame-wearing time or healing index between the two groups after bone transport ( P>0.05). At 6 months after bone transport, the SAS grade in the unilateral fixation group (13 patients with mild anxiety, 8 with moderate anxiety, and 1 with severe anxiety) was better than that in the Ilizarov group (6 patients with mild anxiety, 19 with moderate anxiety, 3 with severe anxiety) ( P<0.01). No significant differences were found in the Paley score or ASAMI score between the two groups at the last follow-up ( P>0.05). There were no significant differences in HSS knee score or Baird-Jackson ankle score between the two groups on admission, after external fixator removal or at the last follow-up ( P>0.05). No significant differences were observed in the incidence of pin tract infection, poor healing, infection in the bone elongation area, or re-fracture between the two groups ( P>0.05). The incidence of postoperative axial deviation was 0 in the Ilizarov group, lower than 18% in the unilateral fixation group (4/22) ( P<0.05). Conclusion:Although Ilizarov ring external fixation and unilateral rail external fixation demonstrate comparable efficacy in the treatment of infected bone defects after surgery for tibial fractures, the former provides superior mechanical stability and postoperative axial deviation correction, while the latter offers advantages in reducing psychological burden and enhancing treatment tolerance.

Clamshell incision is widely used in the surgical resection of complex mediastinal tumors, but it is also controversial. Its advantages are the full exposure of the field of vision and the huge operating space, while its disadvantages are the destruction of chest wall muscles and respiratory function impairment. At present, there is a lack of norms for the selection and application of Clamshell incisions, and the definition of complex mediastinal tumors is ambiguous and the dimensions are single. Therefore, this article reviews the literature and combines practical experience to systematically summarize the application progress of Clamshell incisions in the surgical resection of complex mediastinal tumors, with the aim of providing guidance for clinical work.

Objective To evaluate the clinical efficacy,safety,and potency ratio of microwave ablation(MW A)combined with percutaneous osteoplasty(POP)for the treatment of flat bone metastases.Methods A total of 57 patients with flat bone metastases complicated by intractable pain,who underwent MWA combined with POP(combination therapy)or only POP(pure POP therapy)at the Zhongshan Municipal People's Hospital of China between January 2016 and January 2023,were enrolled in this study.The combination therapy group had 36 patients and the pure POP therapy group had 21 patients.Visual analog scale(VAS),Oswestry Disability Index(ODI),quality of life assessment scale(QOL)were used to evaluate the preoperative and the postoperative different period efficacy,and the results were compared between the two groups.The procedure-related complications in both groups were recorded.Results The technical success rate in the 57 patients was 100％,and no serious postoperative complications occurred.The mean follow-up time was(4.7±1.3)months(range of 3.4-7.2 months).The preoperative and the postoperative one-day,one-week,one-month and 3-month VAS scores in the combination therapy group were(7.39±1.09)points,(6.53±1.17)points,(1.94±0.70)points,(1.11±0.66)points and(1.39±0.59)points respectively,which in the pure POP therapy group were(7.52±1.01)points,(6.81±0.66)points,(3.38±0.65)points,(2.33±0.56)points and(2.52±0.50)points respectively.One week after operation,the VAS scores in the combination therapy group and the pure POP therapy group were decreased by(5.44±1.32)points and(4.14±0.96)points respectively.The differences in the postoperative one-week(t=-7.62,P＜0.01),one-month(t=-7.28,P＜0.01)and 3-month(t=-7.58,P＜0.01)VAS scores between the two groups were statistically significant.The preoperative and the postoperative one-day,one-week,one-month and 3-month ODI scores in the combination therapy group were(44.33±2.91)points,(44.08±2.82)points,(15.92±3.04)points,(14.00±2.39)points and(16.08±3.61)points respectively,which in the pure POP therapy group were(45.67±3.03)points,(45.14±2.80)points,(22.38±3.09)points,(19.76±2.99)points and(22.10±3.10)points respectively.One week after operation,the ODI score in the combination therapy group was decreased by(28.42±4.23)points,which in the pure POP therapy group was decreased by(23.29±4.28)points.The differences in the postoperative one-week(t=-7.50,P＜0.01),one-month(t=-7.37,P＜0.01)and 3-month(t=-6.51,P＜0.01)ODI scores between the two groups were statistically significant.The preoperative and the postoperative one-day,one-week,one-month and 3-month QOL scores in the combination therapy group were(24.69±3.92)points,(26.06±3.05)points,(38.67±3.00)points,(40.25±3.42)points and(39.58±3.99)points respectively,which in the pure POP therapy group were(24.43±3.53)points,(26.76±3.05)points,(32.81±2.17)points,(33.95±2.68)points and(31.19±4.27)points respectively.One week after operation,the QOL score in the combination therapy group was increased by(13.97±4.88)points,which in the pure POP therapy group was increased by(8.38±4.50)points.The differences in the postoperative one-week(t=8.34,P＜0.01),one-month(t=7.56,P＜0.01)and 3-month(t=7.18,P＜0.01)QOL scores between the two groups were statistically significant.The mean operation cost in the combination therapy group was 10 480.43 Chinese yuan,which was higher than that in the pure POP therapy group.Conclusion For the treatment of flat bone metastases,both pure POP therapy and MWA combined with POP therapy are clinically safe and effective,which can significantly relieve pain and improve quality of life.Compared with pure POP therapy,the MWA combined with POP therapy is more effective but its medical cost is more expensive.

Objective:To explore the epidemiology and clinical characteristics of hospitalized patients with acute poisoning at the First Affiliated Hospital of Nanchang University in Jiangxi Province.Methods:Based on the electronic medical records management platform of the First Affiliated Hospital of Nanchang University, a retrospective analysis was conducted on hospitalized patients with acute poisoning based on ICD-10 disease codes from 2014 to 2021. The gender, age, residence, poison type, etiology, route of exposure, illness severity, diagnostic and therapeutic processes, hospital stay duration, and prognosis of patients were collected.Results:A total of 1 953 cases of acute poisoning were included, comprising 871 males (44.6%) and 1 082 females (55.4%). The age was (42.7±20.0) years, with 113 fatalities (5.8%). Urban residents accounted for 706 cases (36.1%) and rural residents for 1 247 cases (63.9%). The highest incidence occurred in the 41-60 age group. Suicide was the primary cause, constituting 1 318 cases (67.5%), followed by accidental ingestion or contact, with overdose being less frequent. Oral poison way was the predominant route (1 681 cases, 86.1%), followed by inhalation and contact. Pesticide poisoning was the predominant type of poisoning in this study, with 847 cases (43.4%), followed by drug poisoning and foodborne poisoning. Pesticide poisoning predominated among rural residents (79.2%), while drug poisoning was more prevalent among urban residents (53.5%).Conclusions:In this study, patients with acute poisoning exhibited predominantly female gender, hailed from rural areas, and primary etiology of poisoning was pesticide ingestion for suicidal intent. Targeted education and control measures should be carried out for the above high-risk areas, populations and poisons.