ObjectiveTo develop and validate a diagnostic prediction model for differentiating pulmonary tuberculosis from community-acquired pneumonia based on routine blood parameters. MethodsA total of 642 patients with pulmonary tuberculosis and 503 patients with community-acquired pneumonia were retrospectively enrolled from the Seventh Hospital of Tangshan. They were randomly divided into a training set and an internal validation set at a 7∶3 ratio. Additionally， 218 patients from the 981st Hospital were independently included as an external validation set. The Boruta algorithm and recursive feature elimination were employed to select predictors from 82 blood parameters， sex， and age. A multivariate Logistic regression model was established and evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis. ResultsThe final model incorporated eight predictors， namely uric acid， urea nitrogen， alkaline phosphatase， monoamine oxidase， alanine aminotransferase， glutathione， neutrophil percentage， and age. The model achieved areas under the curve （AUCs） of 0.800 （95%CI： 0.769-0.830）， 0.787 （95%CI： 0.738-0.836）， and 0.736 （95%CI： 0.667-0.835） in the training， internal validation， and external validation sets， respectively. The model demonstrated good calibration， and decision curve analysis showed clinical net benefit within the threshold probability range of 10%-80%. ConclusionThe developed model exhibits good discriminative ability and clinical utility， serving as an effective early screening tool for primary healthcare institutions.

Objective To investigate the clinical efficacy of fire dragon pot comprehensive therapy in patients with knee paralysis due to liver and kidney deficiency following total knee arthroplasty(TKA).Methods A total of 114 patients undergoing unilateral TKA were randomly assigned to two groups using a random number table.The control group(n=57)received standard enhanced recovery after surgery(ERAS)nursing care,while the intervention group(n=57)received high-frequency general massage(HGM)therapy in addition to the standard ERAS protocol.Outcomes including visual analogue scale(VAS)scores,Hamilton Anxiety Scale(HAMA)scores,Hospital for Special Surgery(HSS)knee scores,and serum levels of inflammatory markers[C-reactive protein(CRP),neutrophil count(NE),and lymphocyte count(LY)]were compared between the two groups.Results Compared with the control group,the intervention group exhibited significantly lower VAS scores at 3 days postoperatively and at discharge,reduced HAMA scores from the preoperative period through 3 days after surgery,improved HSS scores[specifically in pain,function,range of motion,stability,and total score]at 2 weeks postoperatively,and more pronounced improvements in inflammatory markers,including lower levels of CRP and NE and higher LY levels(all P<0.05).Conclusion The comprehensive moxibustion therapy using Huolongjar effectively alleviates postoperative pain following TKA,enhances joint function,reduces anxiety levels,and mitigates inflammatory responses.This intervention is safe,simple to administer,and holds promise for clinical application and wider dissemination.

Objective To investigate the clinical efficacy of fire dragon pot comprehensive therapy in patients with knee paralysis due to liver and kidney deficiency following total knee arthroplasty(TKA).Methods A total of 114 patients undergoing unilateral TKA were randomly assigned to two groups using a random number table.The control group(n=57)received standard enhanced recovery after surgery(ERAS)nursing care,while the intervention group(n=57)received high-frequency general massage(HGM)therapy in addition to the standard ERAS protocol.Outcomes including visual analogue scale(VAS)scores,Hamilton Anxiety Scale(HAMA)scores,Hospital for Special Surgery(HSS)knee scores,and serum levels of inflammatory markers[C-reactive protein(CRP),neutrophil count(NE),and lymphocyte count(LY)]were compared between the two groups.Results Compared with the control group,the intervention group exhibited significantly lower VAS scores at 3 days postoperatively and at discharge,reduced HAMA scores from the preoperative period through 3 days after surgery,improved HSS scores[specifically in pain,function,range of motion,stability,and total score]at 2 weeks postoperatively,and more pronounced improvements in inflammatory markers,including lower levels of CRP and NE and higher LY levels(all P<0.05).Conclusion The comprehensive moxibustion therapy using Huolongjar effectively alleviates postoperative pain following TKA,enhances joint function,reduces anxiety levels,and mitigates inflammatory responses.This intervention is safe,simple to administer,and holds promise for clinical application and wider dissemination.

Preliminary exploration of using ultrasound to quantitatively evaluate the development of epiphyseal cartilage and analyze its correlation with bone age, based on the ultrasound findings of the long bone joint end.

To research on area ossification ratio (AOR), a novel parameter for quantitatively assessing adolescent bone age by conventional ultrasonography, and evaluate the correlation between AOR and radiographic bone age.

Bone age, the most commonly used and effective indicator for understanding children's growth and development, plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders. Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of ultrasound in bone age assessment. This article, by reviewing the latest literature, discusses the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, raises the problems in the study of ultrasound assessment of bone age, and suggests direction for improvement.

Objective To explore the effects of preserved voluntary breathing non-intubated video-assisted thoracic surgery (NIVATS) on hemodynamics and cerebral oxygen metabolism in patients. Methods From May 2020 to September 2021,120 patients undergoing elective thoracoscopic radical resection of lung cancer or lung wedge resection,aged 33-67 years,American Society of Anesthesiologists grades Ⅰ-Ⅱ,were selected and randomly divided into the NIVATS group (with laryngeal mask ventilation for preserving spontaneous respiration) and the IVATS group (with intraoperative one-lung ventilation with double-lumen tracheal intubation),with 60 patients in each group. The cardiac output (CO),stroke volume variation (SVV),heart rate variation (HRV),oxygen saturation (SpO2),arterial partial pressure of oxygen (PaO2),and partial pressure of carbon dioxide (PaCO2) were recorded,and the jugular venous oxygen content (CjvO2) was monitored to calculate the arterio-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction ratio (CERO2) at five time points. These points were before anesthesia induction (T0),immediately after intubation (laryngeal mask,T1),30 min (T2) and 60 min (T3) after the start of surgery (one-lung ventilation),and 15 min (T4) after extubation (laryngeal mask). Results No statistically sig-nificant differences were observed in the scores for satisfaction with anesthesia and the surgical field,duration of anesthesia,or duration of surgery between the two groups (P>0.05 for all). In addition,no statistically significant differences were observed in intraoperative blood loss,intraoperative colloid fluid usage,crystalloid fluid usage,and the number of lymph nodes dissected (P>0.05 for all). Compared with the IVATS group,CO was significantly higher and SVV was significantly lower (P<0.05) at T1,T2,and T3 in the NIVATS group. The diffe-rence in HRV between the two groups at each time point was significant (P<0.05). The PaO2 and CjvO2 in the two groups at T2 and T3 were significantly different (P<0.05). Da-jvO2 and CERO2 were significantly higher in the NIVATS group than in the IVATS group at T2,T3,and T4 (all P<0.05). In addition,the PaCO2 was significantly higher in the NIVATS group than in the IVATS group at T1,T2,and T3 (all P<0.05). Conclusion Compared with one-lung ventilation during double-lumen endotracheal intubation,the intraoperative hemo-dynamic indicators (CO,SVV,and HRV) of patients under NIVATS who maintained spontaneous breathing tended to be more stable,whereas the cerebral oxygen metabolism indicators (Da-jvO2 and CERO2) remained at a higher level. This may exhibit a positive effect on the recovery of cognitive function after thoracoscopic surgery.

Objective To explore the effects of preserved voluntary breathing non-intubated video-assisted thoracic surgery (NIVATS) on hemodynamics and cerebral oxygen metabolism in patients. Methods From May 2020 to September 2021,120 patients undergoing elective thoracoscopic radical resection of lung cancer or lung wedge resection,aged 33-67 years,American Society of Anesthesiologists grades Ⅰ-Ⅱ,were selected and randomly divided into the NIVATS group (with laryngeal mask ventilation for preserving spontaneous respiration) and the IVATS group (with intraoperative one-lung ventilation with double-lumen tracheal intubation),with 60 patients in each group. The cardiac output (CO),stroke volume variation (SVV),heart rate variation (HRV),oxygen saturation (SpO2),arterial partial pressure of oxygen (PaO2),and partial pressure of carbon dioxide (PaCO2) were recorded,and the jugular venous oxygen content (CjvO2) was monitored to calculate the arterio-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction ratio (CERO2) at five time points. These points were before anesthesia induction (T0),immediately after intubation (laryngeal mask,T1),30 min (T2) and 60 min (T3) after the start of surgery (one-lung ventilation),and 15 min (T4) after extubation (laryngeal mask). Results No statistically sig-nificant differences were observed in the scores for satisfaction with anesthesia and the surgical field,duration of anesthesia,or duration of surgery between the two groups (P>0.05 for all). In addition,no statistically significant differences were observed in intraoperative blood loss,intraoperative colloid fluid usage,crystalloid fluid usage,and the number of lymph nodes dissected (P>0.05 for all). Compared with the IVATS group,CO was significantly higher and SVV was significantly lower (P<0.05) at T1,T2,and T3 in the NIVATS group. The diffe-rence in HRV between the two groups at each time point was significant (P<0.05). The PaO2 and CjvO2 in the two groups at T2 and T3 were significantly different (P<0.05). Da-jvO2 and CERO2 were significantly higher in the NIVATS group than in the IVATS group at T2,T3,and T4 (all P<0.05). In addition,the PaCO2 was significantly higher in the NIVATS group than in the IVATS group at T1,T2,and T3 (all P<0.05). Conclusion Compared with one-lung ventilation during double-lumen endotracheal intubation,the intraoperative hemo-dynamic indicators (CO,SVV,and HRV) of patients under NIVATS who maintained spontaneous breathing tended to be more stable,whereas the cerebral oxygen metabolism indicators (Da-jvO2 and CERO2) remained at a higher level. This may exhibit a positive effect on the recovery of cognitive function after thoracoscopic surgery.

Objective:To develop a deep transfer learning method for the differential diagnosis of osteonecrosis of the femoral head (ONFH) with other common hip diseases using anteroposterior hip radiographs.Methods:Patients suffering from ONFH, DDH, and other hip diseases including primary hip osteoarthritis, non-infectious inflammatory hip disease, and femoral neck fracture treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to December 2020 were enrolled in the study. A clinical data set containing anteroposterior hip radiographs of the eligible patients was created. Data augmentation by rotating and flipping images was performed to enlarge the data set, then the data set was divided equally into a training data set and a testing data set. The ResNet-152, a deep neural network model, was used in the study, but the original Batch Normalization was replaced with Transferable Normalization to construct a novel deep transfer learning model. The model was trained to distinguish ONFH and DDH from other common hip diseases using anteroposterior hip radiographs on the training data set and its classification performance was evaluated on the testing data set.Results:The clinical data set was comprised of anteroposterior hip radiographs of 1024 hips, including 542 with ONFH, 296 with DDH, and 186 with other common hip diseases (56 hips with primary osteoarthritis, 85 hips with non-infectious inflammatory osteoarthritis, 45 hips with femoral neck fracture). After data augmentation, the size of the data set multiplied to 6144. The model was trained 100 050 times in each task. Accuracy was used as the representative parameter to evaluate the performance of the model. In the binary classification task to identify ONFH, the best accuracy was 95.80%. As for the multi-classification task for classification of ONFH and DDH from other hip diseases, the best accuracy was 91.40%. The plateau of the model was observed in each task after 50 000 times of training. The mean accuracy in plateaus was 95.35% (95% CI: 95.33%, 95.37%), and 90.85% (95% CI: 90.82%, 90.87%), respectively. Conclusion:The present study proves the encouraging performance of a deep transfer learning method for the first-visit classification of ONFH, DDH, and other hip diseases using the convenient and economical anteroposterior hip radiographs.

Different degrees of visual function impairment is the main reason for first visit of children with optic pathway glioma; it seriously affects the quality of life of children. Early diagnosis, timely treatment, maximum preservation or restoration of the children's vision function, and improvement of quality of life of children are major challenges. This article reviews the recent advance in visual function assessments for children with optic pathway glioma, aiming to provide some references for early clinical objective assessment of visual function impairment and clear diagnosis.