As a fundamental aspect of bone fracture treatment, fracture reduction plays a decisive role in restoring the structural integrity and function of bones. At present, fracture reduction techniques mostly rely on semi-automatic interaction methods or healthy-side bone templates for registration, which have many limitations in clinical practice. In order to enhance treatment efficiency and accuracy, an automatic fracture reduction algorithm is proposed. This algorithm utilizes the similarity of fracture cross-sections for registration, thereby reducing the workload of physicians and eliminating the need for a healthy-side bone template. Initially, the closed edge is identified and extracted by analyzing the differences in the fracture surface and the calorific value diagram of the roughness distribution. Next, the fracture section is determined by using the identified closed edge as a guideline for regional expansion and similarity matching. During the registration phase, the iterative closest point (ICP) algorithm is highly sensitive to distance. Therefore, the geometric features of point clouds are incorporated into the objective function of the registration algorithm to mitigate the influence of noise, and fracture section registration is implemented one by one. Finally, the algorithm is tested and compared on 180 simulated datasets and 16 publicly available datasets. The results show that the proposed algorithm significantly improves the registration accuracy, and the registration error of clinical bone fracture cases is controlled within 1.7 mm.
Algorithms ; Fractures, Bone/therapy* ; Humans

Purpose To explore the clinical value of quantitative assessment of renal perfusion using ultrasound contrast imaging for the auxiliary diagnosis of type 2 diabetic nephropathy.Materials and Methods This prospective study was conducted from May 2017 to December 2019 at the First Medical Center of Chinese PLA General Hospital.A total of 41 patients with type 2 diabetes and renal function abnormalities,who were scheduled for renal biopsy,underwent contrast-enhanced ultrasound.Differences in contrast imaging parameters,including time to peak in the renal cortex,peak enhancement,mean transit time local,and area under the curve between diabetic nephropathy and focal segmental glomerulosclerosis were compared,and the correlation between imaging parameters and pathological results was analyzed.Results Among 41 patients,30 cases were diagnosed as diabetic nephropathy,and 11 cases were diagnosed as focal segmental glomerulosclerosis.The peak enhancement and area under the curve in the diabetic nephropathy group were significantly lower than those in the focal segmental glomerulosclerosis group[peak enhancement:3 837.16(2 449.16,5 929.16)vs.8 508.00(4 334.88,21 201.00),Z=-2.766,P=0.006;area under the curve:0.14±0.05 vs.0.19±0.05,t=-3.135,P=0.003].In the diabetic nephropathy group,peak enhancement showed a negative correlation with the global glomerulosclerosis rate(r=-0.489,P=0.006).Conclusion Contrast-enhanced ultrasound can quantitatively evaluate renal perfusion and has certain clinical value in assisting the diagnosis of type 2 diabetic nephropathy.

Colonoscopy is an important technical means for screening early colorectal cancer lesions.Accurate segmentation of intestinal polyps helps improve the accuracy of screening.Early screening for lesions is of great significance for the prevention of colorectal cancer,and the segmentation of intestinal polyps is an important research direction.Although intestinal polyp segmentation based on deep learning has achieved acceptable performance,the color variation among intestinal endoscopic images significantly affects it.Based on the ResNet architecture,this study proposes an advanced PE-ResNet in which histogram equalization is used to reduce color influence.Experimental results on five datasets,including ClinicDB,demonstrate that the PE-ResNet model achieves improved performance in intestinal polyp segmentation.

The occurrence, progression, and prognosis of renal diseases are closely linked to renal blood perfusion.Accurate evaluation of renal perfusion is essential for clinical assessment of kidney function.Unlike CT and MRI, contrast-enhanced ultrasound(CEUS)is a non-invasive, convenient, real-time imaging technique that enables quantitative assessment of renal cortical perfusion, providing microcirculation information for clinical diagnosis.This review article discusses the clinical relevance of CEUS in evaluating renal cortical perfusion status.

Epidermal growth factor receptor (EGFR) mutations are the most common driver genes in the development of non-small cell lung cancer (NSCLC), of which mutations in exons 18-21 are frequent, especially the loss of exon 19 and exon 21 L858R mutation are the most frequent. Other rare gene mutations are rare. Simultaneous occurrence of two or more rare EGFR mutations are extremely rare in lung cancer, and the incidence of EGFR L833V/H835L rare gene compound mutations is very low, and there is little clinical data and evidence of relevant treatment methods. Some EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are effective in treating lung cancer patients with rare gene mutations. In this article, we reported a case of NSCLC patient with a rare gene compound mutation EGFR L833V/H835L, who responded to Afatinib in combination with Anilotinib treatment well after 5 months of treatment, and computed tomography (CT) showed shrinkage of lung lesions. Meanwhile, we also compiled previously reported NSCLC patients with EGFR L833V/H835L rare gene compound mutation and summarized the characteristics of this group of patients and the effect of applying different kinds of EGFR-TKIs treatment.
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Humans ; Adenocarcinoma of Lung/genetics* ; Carcinoma, Non-Small-Cell Lung/pathology* ; ErbB Receptors/genetics* ; Lung Neoplasms/pathology* ; Mutation ; Protein Kinase Inhibitors/therapeutic use*

Objective To analyze the clinicopathological features and prognosis of polyomavirus nephropathy (PyVN) after kidney transplantation. Methods Clinical data of 44 patients who were diagnosed with PyVN after kidney transplantation were retrospectively analyzed. The causes of puncture and the time of pathological diagnosis were analyzed. Histological grading was carried out according to Banff 2018 classification. Clinical data and pathological characteristics of patients at all grades were statistically compared. BK viral DNA loads in the blood and urine were measured and renal allograft function were assessed. Clinical prognosis of all patients was compared among different groups and the risk factors affecting clinical prognosis were also analyzed. Results The time interval between pathological diagnosis of PyVN and kidney transplantation was 16(8, 29) months, and the increase of serum creatinine level was the main cause for puncture. Among 44 patients, 19 cases were classified as grade ⅠPyVN, 21 cases of grade Ⅱ PyVN and 4 cases of grade Ⅲ PyVN, respectively. Under optical microscope, there was no significant difference in the positive rate of virus inclusion bodies among different groups (P=0.148). Inflammatory cell infiltration, interstitial fibrosis and polyomavirus load in grade Ⅱ PyVN patients were all more or higher than those in grade Ⅰ counterparts. Inflammatory cell infiltration and polyomavirus load in grade Ⅲ patients were more or higher than those in grade Ⅰ counterparts. Polyomavirus load in grade Ⅲ patients was more or higher than that in grade Ⅱ counterparts. The differences were statistically significant (all P < 0.05/3). Upon diagnosis, BK viral DNA load was detected in the blood and urine of 39 patients. Among them, 38 patients were positive for BK virus in the urine and 30 patients were positive for BK virus in the blood. The serum creatinine level upon diagnosis was higher compared with that at postoperative 1 month. The serum creatinine level at the final follow-up was significantly higher than that upon diagnosis. The differences were statistically significant (P < 0.001, P=0.049). There was no significant difference in the serum creatinine level among patients with different grades of PyVN at postoperative 1 month (P=0.554). The serum creatinine level of patients with grade Ⅱ PyVN upon diagnosis was significantly higher than that of those with grade Ⅰ PyVN (P=0.007). The 1-, 3- and 5-year cumulative survival rates of renal allografts were 95%, 69% and 62%, respectively. The survival rates of renal allografts significantly differed among patients with different grades of PyVN. The higher the grade, the lower the survival rate (P=0.014). Univariate and multivariate Cox's regression analyses prompted that intrarenal polyomavirus load and serum creatinine level upon diagnosis were the independent risk factors for renal allograft dysfunction (all P < 0.05). Conclusions PyVN mainly occurs within 2 years after kidney transplantation. Clinical manifestations mainly consist of increased serum creatinine level, BK viremia and BK viruria. Postoperative routine monitoring of BK virus contributes to early diagnosis and protection of renal allografts. Banff 2018 classification may effectively predict the prognosis of renal allografts.

Stroke is a common nervous system disease with high incidence rate,mortality rate and disability rate.Hydrogen rich water is a type of drinking water containing high concentrations of hydrogen gas,which can be used to treat stroke.Hydrogen rich water mainly plays a role by reducing inflammatory reactions,cell apoptosis,oxidative stress reactions,etc.This article reviews the research progress on the therapeutic effect and mechanism of hydrogen rich water on stroke,in order to provide insights for the treatment plan of stroke.

Objective: To investigate the relationship between insomnia and cognitive function in middle-aged and elderly patients. Methods: Patients aged ≥ 45 years visiting outpatient clinic of You′anmen Community Health Center from October 2016 to December 2016 were enrolled in the study. Among 850 participants there were 159 patients with persistent insomnia, 188 with paroxysmal insomnia (insomnia group) and 503 with normal sleep (normal sleep group) according to DSM-5 diagnostic criteria. The sleep quality and cognition were evaluated using Pittsburgh Sleep Quality Index(PSQI) and Montreal Cognitive Assessment(MoCA) and compared among 3 groups. Relationship between sleep quality and cognition, influencing factors of cognition were explored in this study. Results: The total score and all sub-scores of PSQI in persistent insomnia group were higher than those in the normal sleep group. The total score of PSQI and all sub-scores (except hypnotic drugs and daytime dysfunction) of paroxysmal insomnia group were higher than those of normal sleep group. The total PSQI score and all sub-scores (except sleep disorders) of the persistent insomnia group were higher than those of the paroxysmal insomnia group. The total score of MoCA and the sub-scores of naming, attention, language, abstract thinking, delayed recall and orientation ability of the persistent insomnia group were lower than those of the normal sleep group (P<0.05). The language ability of paroxysmal insomnia group was lower than that of normal sleep group (P<0.05). The language ability of persistent insomnia group was lower than that of paroxysmal insomnia group (P<0.05). The total score of MoCA was negatively correlated with the total score of PSQI and sub-scores of sleep time and sleep efficiency (r=-0.162, -0.131, -0.190; P<0.05). Logistic regression analysis showed that age was a risk factor for cognitive impairment (β=0.038, P=0.000) and sleep efficiency was a protective factor for cognitive function (β=0.260, P=0.000). Conclusion The overall cognitive function of middle-aged and elderly patients with persistent insomnia is poor, the abilities of naming, attention, language, abstract thinking, delayed recall and orientation are decreased; and the cognitive function is associated with age and sleep efficiency.

Objective To examine the association between child-supporting from their folks and elder abuse in China so as to provide evidence for prevention and control of elder abuse.Methods Based on the third survey on the Status of Chinese women,organized by the All-China Women's Federation and the National Bureau of Statistics,7 159 residents aged 65 and older were included and general information on supporting child and elder abuse were gathered.Chi-square test and logistic regression were used to investigate the association between supporting child from elderly and elder abuse.Results The overall prevalence of elder abuse was 6.71％.Risks of elder people being abused by family numbers varied from different supporting child situations.After adjusting for potential confounding factors,ORs for the elderly appeared as follows:OR=1.99 (95％CI:1.56-2.54) for those who only providing support to male children;OR=2.07 (95％CI:1.51-3.79) for those only providing support to the female offspring and OR=2.32 (95％CI:1.72-3.13) for those who did not support their children regardless of their sex identity.Elderly who provided support to their children on both sexes were exposed to lower risk of being abused than those who only supporting their male offspring.There was no significant difference appearing on the risk of elder abuse between those elderly who only supporting the male (OR=1.00) or the female offspring (OR=1.04,95％ CI:0.63-1.71),among all the participants in our study.However,such associations were different in urban and rural areas.Conclusions High prevalence of abuse was seen in China.The pattem of supporting child was associated with risk of elder abuse.Elderly who showed poor support to their children were under higher risk of being abused by their family members.

Objective To provide clues for the diagnosis standard, laboratory examination and pathological mechanism of asthma and chronic obstructive pulmonary disease overlap syndrome(ACOS) by detecting the levels of serum total IgE, fractional exhaled nitric oxide (FeNO) and peripheral blood oxyphil cells in asthma, chronic obstructive pulmonary disease (C0PO) and ACOS. Methods A prospective randomized trial based on hospital was conducted. According to the diagnostic criteria and inclusion criteria, 40 asthma patients(asthma group), 25 cases of patients with COPD(COPD group)and 37 cases of ACOS patients(ACOS group)were collected continuously, and 40 healthy persons(healthy control group) were as the research object. General data and biochemical indexes were tested in each group. The levels of serum total IgE, FeNO and peripheral blood oxyphil cells in each group were observed and compared.The correlation between serum total IgE and other biochemical parameters were analyzed by Pearson correlation analysis. Results The level of total serum IgE in asthma group was significantly higher than that in other groups(P<0.05),and the level of total serum IgE in ACOS group was the second(P<0.05).The level of total serum IgE in healthy control group and COPD group had no significant difference(P>0.05).The level of FeNO in four groups had significant difference(P<0.05), and the level of FeNO in ACOS group and asthma group had significant difference compared with that of COPD group (P < 0.05). The level of peripheral blood oxyphil cells in asthma group, ACOS group, COPD group was significantly higher than that in healthy control group (P < 0.05), and the change of ACOS group was the best obviously.Conclusions Serum total IgE, FeNO and peripheral blood oxyphil cells are specific detection index in ACOS.Combined detection can help to identify ACOS, asthma and COPD, also reveal the presence of airway inflammation in the pathogenesis of ACOS, and can provide the basis for clinical diagnosis, treatment and prevention.