BACKGROUND:Palmar locking plate fixation is the most commonly used fixation method for distal radius fractures.However,when the fracture line involves the dorsal articular surface,palmar plate fixation carries a higher risk of postoperative displacement of the dorsal bone mass,especially the dorsal sigmoid notch bone mass. OBJECTIVE:To analyze the fracture line characteristics of distal radius fracture involving the dorsal articular surface,and further investigate the risk factors of postoperative displacement of the dorsal bone mass involving the sigmoid notch,so as to provide evidence for improving the success rate of surgery. METHODS:Retrospective analysis was performed on patients with distal radius fracture who were admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2021 to September 2022.The number of dorsal fractures of the distal radius of 1,2,3 and above was divided into types Ⅰ,Ⅱ,and Ⅲ based on preoperative CT images.The fracture line maps were drawn respectively to analyze the morphological characteristics of the dorsal fracture lines.Patients with dorsal sigmoid notch fracture were followed up for more than 3 months and divided into displaced group and non-displaced group according to whether the dorsal sigmoid notch bone mass displacement occurred after surgery.Age,sex,preoperative and postoperative CT anatomical parameters were compared between the two groups. RESULTS AND CONCLUSION:(1)145 patients with type C of AO/OTA involving the dorsal articular surface were analyzed by fracture line map.According to the number of dorsal fractures,there were 25 cases of type Ⅰ fracture(17.2％),82 cases of type Ⅱ fracture(56.6％),and 38 cases of type Ⅲ fracture(26.2％).Fracture line map showed that the fracture line of type Ⅰ fracture block mainly involved sigmoid notch;type Ⅱ mainly involved sigmoid notch and lister tubercle,and type Ⅲ involved sigmoid notch,lister tubercle,and dorsal radial column.Among the 145 patients,86.2％(125/145 cases)were involved in sigmoid notch,of which type Ⅲ was involved as high as 94.7％(36/38 cases);type Ⅱ was involved as high as 88.0％(72/82 cases),and type Ⅰ was involved as high as 68％(17/25 cases).(2)76 cases of type C of AO/OTA involving the dorsal sigmoid notch were included for further study,of which 65 cases were not displaced after operation and 11 cases were displaced.In univariate analysis,there were no statistically significant differences between the two groups in age,sex,injury site,preoperative CT dorsal sigmoid notch bone mass length(d1),ulnar length(d2),dorsal height of dorsal sigmoid notch bone mass(d4),and ulnar edge distance between steel plate and radius(d5)(P>0.05).The proportion of dorsal sigmoid notch involving the radioulnar joint:[d2/(d2+d3)],the proportion of articular surface of dorsal sigmoid notch(s1/s2),the distance between the ulnar screw tail and the edge of dorsal sigmoid notch(d6),and the number of screw fixation of dorsal sigmoid notch were statistically significant(P<0.05).(3)Multivariate Logistic regression analysis showed that the number of screw fixation of sigmoid notch was the only risk factor affecting the displacement of sigmoid notch on dorsal ulnar side(P<0.05).(4)It is indicated that type Ⅱ is the most common intra-articular fracture of distal radius involving the back of the radius,followed by type Ⅲ and type Ⅰ with dorsal sigmoid notch bone mass.However,the dorsal sigmoid notch bone mass is prone to postoperative displacement due to the influence of the inferior radioulnar joint ligament,and the fixation of at least one effective screw during the operation can reduce the risk of displacement and help to improve the treatment effect.

BackgroundThe issue of school absenteeism due to school refusal in adolescents has become increasingly prominent. Acceptance and Commitment Therapy （ACT） has been applied successfully to improve depression， anxiety， and psychological flexibility in adolescents， while few studies have tested the effect of ACT intervention on above-mentioned psychological aspects and return-to-school rate in adolescents with school absenteeism. ObjectiveTo explore the effect of ACT on depression， anxiety， psychological flexibility and return-to-school rate in school absenteeism adolescents， and to provide a broader evidence base for clinical interventions. MethodsFrom May to June 2024， a sample of 50 adolescents with Shenzhen school registration who had been suspended from school for more than a consecutive month for school refusal were recruited based on Wechat official account platform. The adolescents were divided into study group and control group by random number table method. Both groups received psychological education with the theme of 'Causes and Coping Strategies of School Refusal'， and study group added a 6-week ACT intervention with weekly 1-hour sessions. At baseline and after treatment， Patients’ Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7） and Comprehensive assessment of Acceptance and Commitment Therapy processes （CompACT） were used for the clinical evaluation. ResultsA total of 45 （90.00%）adolescents completed the study， including 25 in study group and 20 in control group. Analysis revealed that study group scored higher on PHQ-9 and GAD-7， while lower on total CompACT score， openness dimension and awareness dimension compared with control group， with statistical significance （F=7.786， 10.334， 12.922， 14.374， 3.075， P<0.05 or 0.01）. After intervention， the rate of return-to-school was higher in study group than in control group （40.00% vs 10.00%， χ²=5.114， P<0.05）. ConclusionACT intervention for adolescents with school absenteeism may alleviate depression and anxiety， improve their psychological flexibility and increase return-to-school rate.［Funded by the "14^th Five Year Plan" for Social Sciences Project in Jiangxi Province （number， 24JY41D）； Science and Technology Planning Project of Shenzhen Municipality （number， 20210617155253001）］

Healthy dental pulp is essential for preserving teeth and maintaining their normal function. Vital pulp therapy (VPT) is widely used in clinical applications because it aims to preserve vital pulp and enhance the long-term survival of teeth. An accurate diagnosis of pulp vitality is a prerequisite for successful VPT. However, accurately assessing pulp viability remains challenging in clinical practice. Pulp viability is influenced by various factors, including the type of pulp exposure, caries status, periodontitis, trauma, treatment factors, patient age, and individual differences. Assessing pulp viability requires a comprehensive consideration of medical history and clinical manifestations, along with a combination of various auxiliary methods, such as pulp sensibility tests, pulp blood flow tests, imaging techniques and molecular diagnostics. In the future, the technology for assessing pulp vitality should evolve toward chairside, visualization, and precision techniques, to achieve consistency between clinical and histological diagnoses, thereby providing patients with the most effective treatment.

OBJECTIVE: To compare the clinical efficacy of electroacupuncture (EA) at neuro-arterial stimulation points with topical western medication in treating post-stroke shoulder-hand syndrome (SHS). METHODS: A total of 72 patients with post-stroke SHS were randomly assigned to an observation group (n=36, 2 cases dropped out) and a control group (n=36, 3 cases dropped out). Both groups received standard neurological treatment, comprehensive rehabilitation, and physical therapy. The observation group received EA at neuro-arterial stimulation points, including the ipsilateral stellate ganglion point, vagus nerve trunk and auricular branch (left side), and stimulation points of the radial and ulnar arteries, radial nerve, ulnar nerve, and median nerve, once daily for 4 weeks. The control group was treated with topical diclofenac diethylamine emulgel, and mucopolysaccharide polysulfate cream was added for patients with pronounced early-stage edema, twice a day for 4 weeks. The VAS pain score and hand edema volume were recorded before treatment, at 2 and 4 weeks during treatment, and 2 weeks after treatment completion (follow-up). Musculoskeletal ultrasound was used to measure the thickness of the dorsal hand and middle finger skin on the affected side before and after 4 weeks of treatment. RESULTS: Compared before treatment, the VAS pain scores and edema volume of the affected hand in both groups were decreased at week 2, week 4, and follow-up (P<0.05). At week 4, both groups showed lower VAS pain scores and edema volume than those at week 2 (P<0.05); during follow-up, both VAS pain scores and edema volume were further reduced compared to those at week 4 (P<0.05). At week 2, week 4, and follow-up, the VAS scores and edema volume of the affected hand in the observation group were lower than those in the control group (P<0.05). Compared before treatment, the dorsal hand skin thickness and middle finger skin thickness on the affected side were decreased in both groups after 4 weeks of treatment (P<0.05). Compared with the control group, the observation group showed thinner dorsal hand and middle finger skin thickness after 4 weeks of treatment (P<0.05). CONCLUSION EA at neuro-arterial stimulation points effectively alleviates pain and edema in patients with post-stroke SHS, and demonstrates superior efficacy compared to topical western medication.
Humans ; Male ; Female ; Middle Aged ; Electroacupuncture ; Aged ; Stroke/complications* ; Acupuncture Points ; Adult ; Reflex Sympathetic Dystrophy/physiopathology* ; Treatment Outcome ; Hand

OBJECTIVES: This study aimed to investigate the incidence, imaging characteristics, and clinical manifestations of the eruption failure of deciduous molars using panoramic radiographs to provide a foundation for diagnosis and treatment in this population. METHODS: This study retrospectively reviewed panoramic radiographs of children aged 4-8 years obtained from Stomatology Hospital, Zhejiang University School of Medicine between January 2021 and December 2023. A total of 31 331 subjects were included for the radiographic assessment of the tooth eruption failure of deciduous molars. Incidence, radiographic characteristics, and associated complications were documented. Statistical analysis was performed using SPSS 26.0. RESULTS: The incidence of the eruption failure of deciduous molars among children aged 4-8 years was 0.94% (296/31 331). The rate was 1.55 times higher in females than in males, demonstrating a significant gender difference (P<0.001). Among the affected deciduous molars, mandibular first deciduous molars accounted for 76.4%, followed by the mandibular second deciduous molars (13.8%), and the maxillary deciduous molars collectively comprised 9.8%. The severity of eruption disorders was significantly associated with the mesial and distal tilting of adjacent teeth and elongation of the antagonist (P<0.001). CONCLUSIONS The incidence of the eruption failure of deciduous molars in children aged 4-8 years was 0.94%, with a high prevalence in females and a predilection for the mandible, particularly the mandibular first deciduous molar. For deciduous molars with severe eruption failure, early intervention is crucial to mitigate complications such as malocclusion and space loss.
Humans ; Child ; Child, Preschool ; Tooth, Deciduous/diagnostic imaging* ; Female ; Molar/physiopathology* ; Male ; Retrospective Studies ; Tooth Eruption ; Radiography, Panoramic ; Incidence

Objective To establish an artificial intelligence(AI)diagnostic model for the histopathologic diagnosis of extramammary Paget's disease(EMPD)and to evaluate its efficiency for the diagnosis and differential diagnosis of EMPD.Methods All non-tumor skin disease patients who underwent skin tissue biopsy in Department of Dermatology of First Affiliated Hospital of Army Medical University from September 2003 to February 2023 were recruited,and their pathological data were collected,including EMPD,Bowen's disease(BD),squamous cell carcinoma(SCC),and epidermal hyperplasia and hypertrophy.With EMPD as the main research subject,the histopathological images of BD,SCC,and non-tumor skin diseases were included in the study.The histopathological data of 4 types of diseases was classified and diagnosed by ResNet101 and DenseNet121 deep learning neural networks,and the performance of these models was evaluated.Results The AUC values of the ResNet101 diagnostic model for the diagnosis of EMPD,BD,SCC and non-tumor skin diseases on the images at x20 magnification were 0.97,0.98,1.00 and 0.96,respectively,with an accuracy of 0.925±0.011,while the AUC values on the images at x40 magnification were 1.00,0.99,1.00 and 0.97,respectively,with an accuracy of 0.943±0.017.The AUC values of the DenseNet121 diagnostic model for the diagnosis of 4 diseases on the images at x20 magnification were 0.98,0.95,0.99 and 1.00,respectively,with an accuracy of 0.912±0.034,while the AUC values on the images at x40 magnification were 0.99,0.96,1.00 and 1.00,respectively,with an accuracy of 0.971±0.012.Our results indicated that the histopathologic diagnostic model could effectively differentiate EMPD from BD,SCC and non-tumor skin diseases at low power magnification.The FLPOs of ResNet101 was 786.6 M,and the parameter was 4.5 M;The FLPOs of DensNet121 was 289.7 M,and the parameter was 0.8M.Conclusion Our AI diagnostic model is of good effectiveness in the diagnosis and differential diagnosis of EMPD.DenseNet121 is recommended as the dermatopathological diagnostic model of this study.

The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health.Direct pulp capping(DPC)is a vital pulp treatment that involves covering the ex-posed pulp with bioactive materials to promote dentin bridge formation.DPC is commonly used in primary teeth with vi-tal pulp and mechanical pulp exposure not exceeding 1 mm.DPC offers advantages such as minimal invasiveness,com-fort,simplicity of operation and short chair-side time,making it suitable for pediatric dental clinical practice.Early stud-ies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure.Over the years,there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of prima-ry teeth with deep caries.However,due to the limited quality of related studies,DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure,and its widespread use needs further support by more high-quality evidence-based medical research.The success rate of DPC in primary teeth is influenced by factors including pulp status,clinical operations(such as isolation and caries removal),pulp capping material,cavity type,tooth position,coronal sealing,and dental fear.In clinical operation,dentists should accurately assess pulp status and minimize bacte-rial contamination.Mineral trioxide aggregate(MTA)is a DPC agent with relatively sufficient evidence and good thera-peutic effects,and the crown should be tightly sealed after pulp capping.Additionally,the effects of novel biocompati-ble materials such as iRoot BP Plus used in DPC of primary teeth,and the influence of other factors like hemostatic methods on the prognosis of affected teeth,need further exploration.

The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health.Direct pulp capping(DPC)is a vital pulp treatment that involves covering the ex-posed pulp with bioactive materials to promote dentin bridge formation.DPC is commonly used in primary teeth with vi-tal pulp and mechanical pulp exposure not exceeding 1 mm.DPC offers advantages such as minimal invasiveness,com-fort,simplicity of operation and short chair-side time,making it suitable for pediatric dental clinical practice.Early stud-ies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure.Over the years,there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of prima-ry teeth with deep caries.However,due to the limited quality of related studies,DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure,and its widespread use needs further support by more high-quality evidence-based medical research.The success rate of DPC in primary teeth is influenced by factors including pulp status,clinical operations(such as isolation and caries removal),pulp capping material,cavity type,tooth position,coronal sealing,and dental fear.In clinical operation,dentists should accurately assess pulp status and minimize bacte-rial contamination.Mineral trioxide aggregate(MTA)is a DPC agent with relatively sufficient evidence and good thera-peutic effects,and the crown should be tightly sealed after pulp capping.Additionally,the effects of novel biocompati-ble materials such as iRoot BP Plus used in DPC of primary teeth,and the influence of other factors like hemostatic methods on the prognosis of affected teeth,need further exploration.

BACKGROUND:Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures,but its failure rate is still high in clinical practice.Reasonable screw placement is an important factor affecting the stability of internal fixation. OBJECTIVE:To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure. METHODS:From January 2017 to December 2021,data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed.A total of 124 patients were enrolled,including 16 males and 108 females,at the age of≥60 years.According to whether there was internal fixation failure after operation,they were divided into normal group(n=101)and internal fixation failure group(n=23).The patient's age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether the talus screw was inserted,and the number of humeral head screws,were collected.The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film,and the distribution characteristics of the screws in each zone were collected,and the heat map of the screw distribution was drawn. RESULTS AND CONCLUSION:(1)There were no significant differences between the two groups in age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether to insert talus screws,and the number of humeral head screws(P>0.05).(2)The heat map showed that the humeral head screws were evenly distributed in the normal group,mainly scattered in zones 4,6,and 7.However,the screw distribution in the internal fixation failure group was not uniform,mainly concentrated in zones 4 and 6.In addition,in the ideal area of talus screws(7/8 zone),there were significantly more screws in the normal group than in the internal fixation failure group.(3)It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate,the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect.A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation.

Objective To analyze the occupational health status of radiation workers in Guangdong Province. Methods A total of 8 913 radiation workers who underwent occupational medical examination (OME) in Guangdong Province Hospital for Occupational Disease Prevention and Treatment in 2020 were selected as the exposure group, and 2 024 non-radiological workers who underwent health examination in the same hospital in the same period of time were selected as the control group using convenient sampling method. The study analyzed the prevalence of abnormalities in thyroid, eye lens, blood pressure, complete blood count and micronucleus in individuals of the two groups. Results The abnormal rates of eye lens, blood pressure and complete blood count in the radiation workers in the exposure group were higher than those in the control group (23.3% vs 8.0%, 18.6% vs 9.0%, 18.1% vs 8.5%, all P<0.01). However, there was no significant difference in the abnormal rates of thyroid and micronucleus in workers between these two groups (12.8% vs 11.5%, 0.1% vs 0.0%, all P>0.05). The abnormal rates of thyroid, eye lens and blood pressure in radiation workers increased with the exposure period of radiation (all P<0.05). Conclusion Long-term exposure to low-dose ionizing radiation have certain effects on the thyroid, eye lens, and blood pressure of radiation workers, with a time-effect relationship of years of radiation work.