OBJECTIVE: To investigate short-term effectiveness of robot-assisted fracture reduction and fixation combined with arthroscopic exploration for posterolateral depressed tibial plateau fractures. METHODS: Between January 2022 and January 2024, 8 patients with posterolateral depressed tibial plateau fractures (Schatzker type Ⅲ) were treated using robot-assisted fracture reduction and fixation combined with arthroscopic exploration, with simultaneous treatment of concomitant ligament or meniscus tears. There were 3 males and 5 females with an average age of 54.1 years (range, 42-68 years). Injury mechanisms included traffic accidents (3 cases) and falls (5 cases). The time from injury to operation ranged from 2 to 4 days (mean, 3.1 days). Operation time, intraoperative blood loss, hospital stay duration, visual analogue scale (VAS) score for pain, and complications were recorded. Fracture healing and knee Rasmussen scores were assessed radiographically, while knee function was evaluated using range of motion and Hospital for Special Surgery (HSS) scores. RESULTS: All operations were successfully completed. The operation time was 108-129 minutes (mean, 120.1 minutes). The intraoperative blood loss was 10-100 mL (mean, 41.3 mL). The hospital stay duration was 4-7 days (mean, 5.6 days). All incisions healed by first intention without complication such as peroneal nerve injury, vascular damage, or infection. All patients were followed up 32-48 weeks (mean, 40 weeks). Radiographic follow-up confirmed that the knee Rasmussen scores rated as excellent in 8 patients and all fractures healed with the healing time of 12-16 weeks (mean, 13.5 weeks). The VAS score for pain was 2-4 (mean, 2.8) at discharge and improved to 0 at 1 month after operation. The knee range of motion was 80°-110° (mean, 96.1°) at discharge and increased to 135°-140° (mean, 137.9°) at 1 month after operation. At 3 months after operation, the HSS score was 91-94 (mean, 92.8), all graded as excellent. No severe complication, including implant failure, occurred during follow-up. CONCLUSION For posterolateral depressed tibial plateau fractures, the minimally invasive approach combining robot-assisted fracture reduction and fixation with arthroscopic exploration demonstrates multiple advantages, including shorter operation time, reduced intraoperative blood loss, excellent wound healing, fewer complications, and rapid recovery of knee function. This technique achieves satisfactory short-term effectiveness, while its long-term effectiveness requires further evaluation.
Humans ; Male ; Tibial Fractures/surgery* ; Female ; Middle Aged ; Adult ; Arthroscopy/methods* ; Minimally Invasive Surgical Procedures/methods* ; Fracture Fixation, Internal/methods* ; Aged ; Treatment Outcome ; Robotic Surgical Procedures/methods* ; Operative Time ; Range of Motion, Articular ; Fracture Healing ; Length of Stay ; Tibial Plateau Fractures

Objective To establish the rapid identification method of Hedysari Radix wild and cultivated products by integrating the identification characteristics of TCM traits obtained by intelligent senses such as electronic nose and colorimeter based on the multivariate statistical analysis method;To provide new ideas and methods for the formulation of commodity specification standards and the application research of market quality control for Hedysari Radix.Methods Totally 29 batches of samples of Hedysari Radix were detected based on colorimeter and electronic nose technology to obtain their sensory information,and the effective components of Hedysari Radix were determined by high performance liquid chromatography(HPLC)and other methods for joint analysis.After establishing the optimal experimental conditions of Hedysari Radix electronic nose,multivariate statistical analysis methods,such as principal component analysis(PCA),orthogonal partial least squares-discriminant analysis(OPLS-DA)and clustering analysis,were used to establish the identification model of Hedysari Radix wild and cultivated commodities.Results The optimum test conditions of Hedysari Radix electronic nose(particle size of 65 mesh):the sample weight was 2.0 g,the optimum temperature of the sample was 50℃,and the time was 25 min.A single intelligent sensory result could not quickly and accurately identify the two,but the fusion information could quickly identify the wild and cultivated commodities of Hedysari Radix,and the chemical composition had a certain correlation with the color and taste.Conclusion Electronic nose and colorimeter can quickly and accurately distinguish wild and cultivated Hedysari Radix after multivariate statistical analysis,which is simple and feasible.The combined analysis of its related properties and active components can be used for the quality evaluation of Hedysari Radix.

Objective:To assess the quality of low-keV monoenergetic images using deep learning image reconstruction (DLIR) algorithm combined with dual energy CT (DECT) in gastric cancer and to compare them with images from the conventional adaptive statistical iterative reconstruction (ASiR-V) algorithm.Methods:In this cross-sectional study, DECT images of 31 gastric cancer patients in the First Affiliated Hospital of Zhengzhou University were prospectively collected from September 2022 to March 2023. The 55 keV monoenergy images were reconstructed using the DLIR algorithm at low-, medium-, and high-intensity levels (DLIR-L, DLIR-M, and DLIR-H) based on arterial phase and venous phase images, respectively. The 70 keV 40% mixing coefficient (ASiR-V40%) images were reconstructed using the ASiR-V algorithm. In the objective evaluation of images, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for both lesions and muscle were calculated across four sets of reconstructed images. In the subjective evaluation of images, scores were assigned to the overall image quality, lesion visibility, and diagnostic confidence for each set of reconstructed images. Comparisons of SNR and CNR between the 4 groups were made by One-way repeated-measures ANOVA or Friedman′s test. Comparisons of scores were made by Friedman′s test. The P value of pairwise comparison was adjusted using Bonferroni correction methods. Results:In the objective evaluations, CNR lesion, SNR lesion and SNR muscle were highest on the 55 keV DLIR-H images in the arterial and venous phases, and showed a gradually increasing trend on the 70 keV ASiR-V40%, 55 keV DLIR-L, DLIR-M, DLIR-H images ( P<0.05). In subjective evaluations, compared to the 70 keV ASiR-V40% images, overall image quality scores were numerically higher for the 55 keV DLIR-H ( P>0.05), similar or slightly worse for the 55 keV DLIR-M, and significantly lower for the 55 keV DLIR-L ( P<0.05). The lesion visibility and diagnostic confidence on the 55 keV DLIR reconstruction images were higher in both arterial and venous phases than 70 keV ASiR-V40% images ( P<0.05). Conclusions:Compared to the conventional 70 keV ASiR-V40% images, the 55 keV DLIR-H images had higher lesion contrast and diagnostic confidence with lower image noise. The 55 keV DLIR-M images had comparable overall image quality to 70 keV ASiR-V40% images, but the former had higher lesion contrast and diagnostic confidence. The 55 keV DLIR-L was unable to improve image quality to the level of 70 keV ASiR-V40%.

Objective To investigate the clinical features,diagnosis and treatment of congenital epulis,to provide a reference for clinical diagnosis and treatment.Methods Two cases of congenital epulis in the mandible and maxilla of a newborn were reported,and the boundary and size of the tumor were determined by ultrasonography and MRI.The tu-mor was resected under general anesthesia.The previous literature on congenital epulis was reviewed and analyzed.Results Patient 1(male)had a hard mass of approximately 20 mm×15 mm×10 mm in the right mandible immedi-ately after birth.MRI was performed,and the mass was removed.In Patient 2(female),a mass approximately 24 mm×23 mm×20 mm in the oral cavity of the anterior maxillary region was shown on ultrasound at 29 gestational weeks,and the mass grew rapidly in the last trimester.The mass was removed after birth.Postoperative pathological examination re-vealed congenital epulis.The results of the literature review showed that the incidence of congenital epulis is greater in females than in males,and it mainly occurs in the maxillary incisor area.Congenital epulis does not invade bone and does not affect tooth development.When a mass affects a child's breathing or swallowing,it must be surgically removed in a timely manner.Recent studies have shown that there is no evidence of recurrence after surgical resection.The histo-logical origin and etiology of the disease are not clear.Clinically,it is often necessary to distinguish between teratomas and congenital epulis.Regarding the clinical manifestations,teratomas and congenital epulis are similar in appearance,and the main distinguishing point lies in pathological manifestations.Under the microscope,teratomas are observed as mature or immature tissue from various embryonic layers,while congenital epulis involves tightly arranged,homoge-neous,polygonal to microspindle-shaped,medium to large cell compositions of nest-like and ribbon-like cells.Conclu-sion Congenital epulis is a rare oral tumor in neonates.The diagnosis should be based on the location,age,clinical manifestations,and imaging findings.The final diagnosis depends on pathological examination.When congenital epulis tumors affect children's breathing and eating,they should be surgically removed as soon as possible,and there is al-most no recurrence after surgery.

Objective To observe the value of CT radiomics-based nomogram for predicting difference of Lauren types of gastric cancers between endoscopic biopsy and postoperative pathology.Methods Totally 126 patients with gastric cancer diagnosed by surgical pathology were retrospectively analyzed.The patients were divided into concordant group(n=77)and inconsistent group(n=49)according to the concordance between endoscopic biopsy and postoperative pathology results or not,also divided into training set and validation set at the ratio of 2∶1.Clinical predictors were screened,then a clinical prediction model was constructed.Radiomics features were extracted based on venous-phase CT images and screened using L1 regularization.Radiomics models were constructed using 3 machine learning(ML)algorithms,i.e.decision trees,random forests and logistic regression.The nomogram based on clinical and the best ML radiomics model was constructed,and the efficacy and clinical utility of the above models and nomogram for predicting inconsistency of Lauren types of gastric cancers between endoscopic biopsy and postoperative pathology were evaluated.Results Patients'age,platelet count,and arterial-phase CT values of tumors were all independent predictors of inconsistency between endoscopic biopsy and postoperative pathology of Lauren types of gastric cancer.CT radiomics model using random forests algorithm showed better predictive efficacy among 3 ML models,with the area under the curve(AUC)of 0.835 in training set and 0.724 in validation set,respectively.The AUC of clinical model,radiomics model and the nomogram in training set was 0.764,0.835 and 0.884,while was 0.760,0.724 and 0.841 in validation set,respectively.In both training set and validation set,the nomogram showed a good fit and considerable clinical utility.Conclusion CT radiomics-based nomogram had potential clinical application value for predicting inconsistency of Lauren types of gastric cancers between endoscopic biopsy and postoperative pathology.

Objective To observe the value of spectral CT multi-parameter imaging for preoperative predicting lymph node metastasis(LNM)of gastric cancer.Methods Totally 136 patients with gastric adenocarcinoma were retrospectively enrolled.The patients were further divided into LNM group(n=74)and non-LNM group(n=62)according to postoperative pathological findings of lymph nodes status.Clinical data,conventional CT findings and spectral CT parameters were compared between groups.Factors being significant different between groups were included in multivariate logistic regression analysis to screen independent predictors of gastric cancer LNM.Clinical+conventional CT model(model 1),spectrum CT model(model 2)and combined model(model 3)were constructed based on the above independent predictors,respectively.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for preoperative predicting LNM of gastric cancer.Results CT-N stage,CT-T stage,70,100 and 140 keV CT valuestumor at arterial phase(AP),arterial enhancement fraction(AEF)and normalized iodine concentration at venous phase(NICVP)were all independent predictors of gastric cancer LNM(all P＜0.05).AUC of model 3 was 0.846,higher than that of model 1 and model 2(AUC=0.767,0.774,Z=-0.368,-2.373,both P＜0.05)for preoperative predicting LNM of gastric cancer,while the latter two were not significantly different(Z=-0.152,P=0.879).Conclusion Spectral CT multi-parameter imaging could effectively predict LNM of gastric cancer preoperatively.

Purpose/Significance To explore the changes,challenges,key application scenarios and future development directions of generative artificial intelligence(AI)represented by ChatGPT in the field of hospital management,and to provide references for the ap-plication of AI natural language processing(NLP)technology in the field of hospital management in China.Method/Process Through literature review and analysis,the changes and challenges brought about by the rapid development of generative AI in the field of hospital management are sorted out,its key application scenarios and future development directions in the field of hospital management are empha-sized and explored.Result/Conclusion AI has broad application prospects in the field of hospital management,and it should focus on exploring its practical application scenarios and strategic directions to provide reference and guidance for promoting the high-quality de-velopment of public hospitals.

Objective To observe the value of dual-energy CT(DECT)radiomics combined with clinical and CT features for predicting differentiation degree of gastric adenocarcinoma(GAC).Methods Totally 254 patients with GAC were prospectively analyzed and divided into high-grade group(low differentiation GAC,n=88)and low-grade group(middle-high differentiation GAC,n=166)according to pathological results.The patients were also divided into training set(n=203,including 70 high-grade and 133 low-grade GAC)and verification set(n=51,including 18 high-grade and 33 low-grade GAC)at the ratio of 8∶2.Radiomics features were extracted and screened based on venous phase single-level(40,70,100 and 140 keV)DECT,and a multi-energy radiomics model was constructed to predict GAC classification.Univariate analysis and multivariate logistic regression were used to analyze clinical and CT features as well as DECT parameters in training set to construct a clinic-CT model.Then a combined model was constructed through combining clinic-CT model with radiomics model.The predictive efficacy of the models were evaluated,and the calibration degree of the combined model was assessed.Results The area under the curve(AUC)of clinic-CT model,multi-energy radiomics model and combined model was 0.74,0.75 and 0.78 in training set,and 0.73,0.77 and 0.78 in verification set,respectively.Except for AUC of combined model was higher than that of clinic-CT model in training set(P＜0.05),no significant difference of AUC was found among models in training set nor verification set(all P＞0.05).The calibration degree of combined model was good in both training set and verification set(both P＞0.05).Conclusion DECT radiomics combined with clinical and CT features could effectively predict differentiation degree of GAC.

Objective To observe the value of spectral CT parameters for evaluating T staging of advanced gastric cancer(AGC).Methods Totally 155 AGC patients were collected and divided into T2 stage(n=40)and T3/4a stage(n=115)according to postoperative pathology.CT values,water concentration(WC)and iodine concentration(IC)of AGC lesions on 40-140 keV arteriovenous phase single energy level images were measured,and the standardized IC(nIC)and spectral curve slopes k1 and k2 were calculated.Clinical variables and spectral quantitative parameters were compared between groups,and receiver operating characteristic curve was plotted,the area under the curve(AUC)was calculated to evaluate the value of each parameter and model for identifying T2 and T3/4a stage AGC.Results Tumor thickness,proportion of low differentiation degree,CT100kev,CT140kev,and WC values in T3/4a group were all significantly higher than those in T2 group(all P＜0.05).CT140keV of AGC lesions on venous phase images presented the highest discrimination efficacy among single parameters,with AUC of 0.782.AUC of clinical-arterial phase-venous phase model was 0.848,higher than that of clinical model and arterial phase model alone(both P＜0.05)but not significantly different compared with AUC of venous phase model(P＞0.05).Conclusion Spectral CT quantitative parameters,especially venous phase parameters could be used to effectively identify T stage of AGC.Multi-parameter combined models had higher diagnostic value.