Objective To investigate the application value of bedside ultrasound monitoring of quadriceps muscle changes in mechanically ventilated children in the early treatment of ICU-acquired muscle weakness (ICU-AW). Methods Eighty-two pediatric ICU patients with mechanical ventilation for>48 hours were selected. On the day of admission (D₀) and on day 7 (D₇), bedside ultrasound was performed to measure the thickness and cross-sectional area of the rectus femoris and vastus intermedius muscles. Patients were classified using Medical Research Council scores into control group (n = 63) and muscle weakness group (n = 19). Muscle parameters and atrophy rates were compared between groups. Diagnostic performance was assessed using receiver operating characteristic curves. Results The incidence of ICU-AW was 23.17%. At both D₀ and D₇, the average thickness of the rectus femoris, the average thickness of the vastus intermedius, the average area of the rectus femoris, and the average area of the vastus intermedius were significantly different between the two groups (P<0.05). The atrophy rates of the thickness of the rectus femoris and the area of the vastus intermedius were lower in the control group than in the muscle weakness group at both D₀ and D₇ (P<0.05). The area under the receiver operating characteristic curve for quadriceps parameters in diagnosing ICU-AW was 0.871, with a sensitivity of 89.47% and a specificity of 79.37%. Conclusion Bedside ultrasound dynamic monitoring of quadriceps changes enables early identification of ICU-AW and provides a basis for clinical intervention.

Objective To evaluate the value of Bushen Qianggu Formula(BSQGF)applying in the treatment of patients with postmenopausal osteoporotic lumbar vertebral compression fracture(PM-OLVCF)of kidney deficiency and blood stasis type,and to observe its effects on lumbar function and sex hormone profiles.Methods A total of 162 patients with PM-OLVCF of kidney deficiency and blood stasis type treated at Haikou Traditional Chinese Medicine Hospital from February 2023 to June 2024 were collected.The patients were equally randomized into a control group and an observation group by using a table of random numbers,with 81 cases in each group.Both groups received percutaneous kyphoplasty and conventional western treatment with analgesics and antibiotics after the operation.Moreover,the control group received oral use of Alfacalcidol+Calcium Carbonate D3 Tablets postoperatively,while the observation group received additional BSQGF decoction orally for 12 weeks.Primary outcomes included Cobb angle,Oswestry Disability Index(ODI),traditional Chinese medicine(TCM)syndrome scores,bone mineral density(BMD),and serum levels of preadipocyte factor 1(Pref-1),thromboxane B2(TXB2),cyclooxygenase 2(COX-2),interleukin 6(IL-6),prostaglandin E2(PGE2),bone morphogenetic protein 2(BMP-2),and relative sex hormones.After treatment,therapeutic effects of patients in both groups were evaluated.Results(1)After 12 weeks of treatment,the total effective rate in the observation group was 93.83%(76/81)and that in the control group was 83.95%(68/81),and the observation group showed significantly better therapeutic efficacy than the control group(χ2=8.134,P＜0.05).(2)After 12 weeks of treatment,both groups showed reductions in Cobb angle,ODI scores,and total TCM syndrome scores compared to those before treatment(P＜0.05),and the observation group demonstrated significantly greater reductions than the control group(P＜0.05).(3)After 6 and 12 weeks of treatment,BMD values were increased in both groups compared to those before treatment(P＜0.05),and the observation group showed significantly greater increase of BMD at both 6 and 12 weeks than the control group(P＜0.05).(4)After 2 weeks of treatment,serum TXB2,COX-2,Pref-1,PGE2,and IL-6 levels were decreased while serum BMP-2 level was increased in both groups compared to those before treatment(P＜0.05),and the observation group showed significantly greater reductions in TXB2,COX-2,Pref-1,PGE2,and IL-6 levels and greater increase of BMP-2 level than the control group(P＜0.05).(5)After 12 weeks of treatment,the control group showed no significant changes in serum levels of luteinizing hormone(LH),estradiol(E2),or follicle-stimulating hormone(FSH)(P＞0.05),while the observation group showed decreased serum LH and FSH levels(P＜0.05)and increased serum E2 level(P＜0.05)compared to those before treatment.The intergroup comparison showed that the observation group had more improvements in all these sex hormone indicators than the control group(P＜0.05).Conclusion BSQGF combined with conventional western medicine therapy is effective on inhibiting the secretion of inflammatory factors,promoting fracture healing,and improving lumbar function in patients with PM-OLVCF of kidney deficiency and blood stasis type,and enhances the therapeutic efficacy compared to western medicine treatment alone.

Objective: To investigate the changes of osteogenic genes and osteogenic capacity after overexpression of bone morphogenetic protein 2(Bmp2) in rat adipose stem cells． Methods: Bmp2 was transfected into rat adipose stem cells by electrotransfection，and the blank group was used as control．The cells were divided into blank group ( Control group) ，empty load group (Vector group) ，osteogenesis induction group (Inducement group) ，and overexpression group (Bmp2 group) ．Western blot，qRT-PCR and immunofluorescence were used to compare the expression of osteogenic genes，and alkaline phosphatase staining and alizarin red staining were used to observe cobalt sulfide precipitation and calcium salt deposition. Results : Western blot and qRT-PCR showed that the expression of Bmp2，Bmp4，OPN，OCN，Runx2，P-Smad1 /5，Dlx2，and BSP was significantly higher compared to the Control group (P ＜0. 05 ) ，while the expression of Smad1 /5 was not statistically different． Immunofluorescence showed that the fluorescence intensity of OPN and Runx2 was significantly higher compared to the Control group (P ＜0. 05) ．The alizarin red staining and alkaline phosphatase staining showed that the Bmp2 group had increased pericellular calcium salt deposition，increased cobalt sulfide precipitation，and enhanced alkaline phosphatase activity compared to the Control group． Conclusion Overexpression of Bmp2 enhances osteogenic gene expression in adipose stem cells and improves their osteogenic ability.

OBJECTIVE: To explore the integration method and technical realization of artificial intelligence bone age assessment system with the hospital RIS-PACS network and workflow. METHODS: Two sets of artificial intelligence based on bone age assessment systems (CHBoneAI 1.0/2.0) were developed. The intelligent system was further integrated with RIS-PACS based on the http protocol in Python flask web framework. RESULTS: The two sets of systems were successfully integrated into the local network and RIS-PACS in hospital. The deployment has been smoothly running for nearly 3 years. Within the current network setting, it takes less than 3 s to complete bone age assessment for a single patient. CONCLUSIONS The artificial intelligence based bone age assessment system has been deployed in clinical RIS-PACS platform and the "running in parallel", which is marking a success of Stage-I and paving the way to Stage-II where the intelligent systems can evolve to become more powerful in particular of the system self-evolution and the "running alternatively".
Age Determination by Skeleton ; Artificial Intelligence ; Bone and Bones ; Hospital Information Systems ; Hospitals ; Humans ; Radiology Information Systems ; Systems Integration

Objective: To explore the feasibility and applicability of a novel cavernosum-free surgical technique for concealed penis of children. Methods: From June 2017 to August 2017, 38 boys with concealed penis were treated using our new cavernosum-free surgical technique. The median age was 8.5 years(4-13 years). The technique consisted of 3 steps: Step 1, making a horizon incision and expose the glans; Step 2, suturing skin of penis to the corresponding side of inguinal ligament medial crus at 2 and 10 o′clock without fixing of cavernosum.Step 3, pruning the foreskin and suturing together. No catheter was placed after surgery. Results: All the patients were able to urinate 2 to 6 hours after operation. The numeric rating scales score of postoperative pain was 1-3. Wound dressing was removed 5 to 7 days post-operatively. All of the parents had good cosmetic appearance, penis stretched naturally without deflection. The length of penis increased more than 3.0 cm on average after operation.Edema was observed in 3 cases, but disappeared in 5-7 days.No serious complications such as bleeding or winding occurs. Conclusions The novel cavernosum-free surgical technique is easy to perform. It provides a safe and effective technique for concealed penis of children.

Objective To evaluate the value of serum kaliuretic peptide (KP) in predicting atrial fibrillation (AF) and its prognosis,by detecting serum KP levels in patients with severe sepsis.Methods Fifty-six patients with severe sepsis in Integrated Intensive Care Unit of Shajing Hospital of Shenzhen Affiliated to Guangzhou Medical University from January 2014 to August 2015 were collected as the case group.In addition 20 cases health checkup for the same period were collected as the control group.Serum KP were determined in all patients in the case group every day for 1 week after admission,meanwhile the APACHE-Ⅱ score was undertook,then according to heart guardianship and electrocardiogram whether occurrence of AF the case group were divided into AF group and non AF group.According to survival after 28 days again divided into survival group and death group,the relationship of serum KP with AF and the prognosis were analyzed.Serum KP was detected on the day of physical examination in the control group.Results (1) The incidence of AF was 32.1％(18/56) in 56 patients with severe sepsis.(2)Serum KP in admission to hospital in case group was significantly higher than that in the control group((234.2±73.5) pmol/L vs.(169.6±65.4) pmol/L;t =3.47,P =0.001).Serum KP in admission to hospital in AF group was significandy higher than that in the non AF group((306.0±35.6) pmol/L vs.(200.2±61.2) pmol/L;t =6.79,P =0.001).Serum KP in AF group before 1 day of the occurrence AF was significantly higher than of the admission to hospital ((339.2± 30.5) pmol/L vs.(306.0±35.6) pmol/L;P=0.007),serum KP on the day of occurrence AF was significantly higher than before 1 days of the occurrence AF((390.6±47.8) pmol/L vs.(339.2±30.5) pmol/L;P=0.006),there was no difference between the serum KP after 1 days of occurrence AF and on the day of occurrence AF(P=0.246),but began to gradually declining.Serum KP and APACHE-Ⅱ score in death group on admission to hospital were significantly higher than survival group((301.1±42.0) pmol/L vs.(199.8±61.5) pmol/L,(26.1±2.8) points vs.(19.9±4.3) points;t =6.44,5.67;P＜0.001).(3) Linear correlation analysis showed that serum KP on admission to hospital was positively correlated with the occurrence of AF(r=0.679,P=0.010).According to AF grouping,serum levels of KP on admission to hospital draw ROC curve,the serum KP of AUC was 0.908(95％ CI:0.831-0.984),when the KP value was 351.5 pmol/L,the sensitivity of the occurrence AF was 89.9％,specificity of 97.4％.(4)Linear correlation analysis showed that serum KP on admission to hospital was positively correlated with death(r=0.659,P =0.010),according to prognostic grouping,serum KP on admission to hospital and APACHE-Ⅱ score ROC curve was drew,the serum KP of AUC was 0.893 (95％ CI:0.811-0.974),when the KP value was 338.5 pmol/L,the sensitivity of death was 78.9％,specificity of 97.3％.Conclusion Early serum KP level can be used as an indicator to predict AF and prognosis in the patients with severe sepsis.

Objective To explore the reasons and management of early relapse of pediatric acute intussusception after enema reduction. Methods Clinical data of 48 patients with early relapse of pediatric acute intussusception after enema reduction were retrospectively collected and analyzed, especially for X-ray data during enema. Relevant management methods were proposed. Results In the comparison of gender, age, admission time and enema pressure between the early relapse group and non-relapse group of children patients, without statistically significant differences(χ2 all <3.84,P>0.05). However, as for①whether X-ray sign of intestinal obstruction could be seen during diagnosis,②whether intus-suscepted parts could be clearly seen after reduction, ③whether intussuscepted parts became larger after pressure re-lief, and ④inflation of small intestine after reduction compared between the two groups, with statistically significant differences (χ2 all>3.84,P<0.05). Patients in the relapse group were all given a secondary enema reduction. Conclu-sion During early stage after reduction of intussusception by air enema, possibilities of relapse or multiple relapses should still be noticed. Observations of multiple repeated changes of body position during enema and special attention to changes of intussuscepted parts are one of critical factors for reducing relapses and ensuring a success for secondary enema. A secondary air enema can be carried out when mastering the indications.

Objective To explore the value of plasma procalcitonin (PCT)detection in dif-ferentiation and judgment of severe pyemia.Methods 70 patients with pyemia were divided into general pyemia group (n =23),severe pyemia group (n =28)and pyemia shock group (n =19), and plasma PCT,lactic acid,c-reactive protein,the acute physiology and chronic health evaluationⅡ 24 hours (APACHE Ⅱ)and 1,2,3 days in hospital as well as serum PCT,lactic acid,c-reac-tive protein were detected and compared.Results Plasma PCT,lactic acid,CRP and APACHE Ⅱscore of pyemia shock patients were significantly higher than the general pyemia group (P <0.05). Serum PCT,CRP and APACHE Ⅱ score of pyemia shock patients were significantly higher than that of severe pyemia group (P <0.05).15 patients with pyemia died,55 patients survived.72 hours plasma PCT,lactic acid,CRP and APACHE Ⅱ score in death group were significantly higher than the survival group (P < 0.01).When pyemia patients were admitted to hospital,PCT were positively correlated with APACHE Ⅱ scores (r =0.528,P <0.01).Conclusion PCT is superior to the current clinical application of CRP inflammatory response parameters,and it can be used as an early identification of systemic infection,judgment of pyemia severity and prognosis judgment in-dex.

Objective To explore the value of plasma procalcitonin (PCT)detection in dif-ferentiation and judgment of severe pyemia.Methods 70 patients with pyemia were divided into general pyemia group (n =23),severe pyemia group (n =28)and pyemia shock group (n =19), and plasma PCT,lactic acid,c-reactive protein,the acute physiology and chronic health evaluationⅡ 24 hours (APACHE Ⅱ)and 1,2,3 days in hospital as well as serum PCT,lactic acid,c-reac-tive protein were detected and compared.Results Plasma PCT,lactic acid,CRP and APACHE Ⅱscore of pyemia shock patients were significantly higher than the general pyemia group (P <0.05). Serum PCT,CRP and APACHE Ⅱ score of pyemia shock patients were significantly higher than that of severe pyemia group (P <0.05).15 patients with pyemia died,55 patients survived.72 hours plasma PCT,lactic acid,CRP and APACHE Ⅱ score in death group were significantly higher than the survival group (P < 0.01).When pyemia patients were admitted to hospital,PCT were positively correlated with APACHE Ⅱ scores (r =0.528,P <0.01).Conclusion PCT is superior to the current clinical application of CRP inflammatory response parameters,and it can be used as an early identification of systemic infection,judgment of pyemia severity and prognosis judgment in-dex.

Objective To investigate the guidance role and effect of the thoracolumbar injury classification and severity score (TLICS) in the choice of anterior,posterior or combined surgery for thoracolumbar fractures.Methods Thirty-one consecutive patients with acute thoracolumbar burst fractures who were treated in an our unit were selected as our subjects who hospitalized from Oct.2006 to Sep 2010,There were 20 male and 11 female patients.The average age was 44.7 years (range from 35.0 to 56.0 of all patients 3 was injured T11,6 at T12,7 at L1,8 at L 2 and 7 at L3.The reasons of injury include motor vehicle accident (10 cases)and falling from a height (24).All patients had preoperative anteroposterior and lateral radiographs,computed tomography (CT) scan,and magnetic resonance imaging (MRI) examination to more fully assess vertebral pieces and nerve compression.According to the Classification of Maged,there were 8 cases with type A3,8 cases with B1,9 cases with B2,3 cases with C1,3 case with C2.Neurologic status based on Frankel classification showed that 4 cases were with grade A 8 with grade B,9 with grade C 6 with grade D and 4 with grade E.Of the 31 patients,11 received posterior surgeries,12 anterior surgeries,and 8 combined anterior and posterior surgeries.Results Twenty-eight cases were followed up with averaged 13.7 months (range from 12.0-17.0 months).The kyphosis angle was measured from the superior endplate to the inferior end plate of the fractured vertebral body using the Cobb technique.The mean cobb's angle was (23.7 ± 11.3) ° (range,13.0 ～ 38.0°) preoperatively,(5.8 ± 0.6°) (-4.0 ～ 6.0) ° lordotic post operatively and (11.3 ± 10.6) ° lordotic at the final observation.The average surgical time was 190 minutes (range,90-380 minutes).and blood loss was 1680 ml (range,1260-2540 ml),and hospital stay was 17.4 days (range,10-24 days).No eloosening or motion was observed in the final follow-up patients.Conclusion TLICS has facilitate treatment decision making of thoracolumbar spinal column injuries and proved to be an effective treatment for serious thoracolumbar fracture.