Objective To propose a classification method for ultrasound images of pedicle screw canals based on radiomics analysis,and to evaluate the integrity of the screw canal.Methods With thoracolumbar spine specimens from 4 fresh cadavers,50 pedicle screw canals were pre-established and ultrasound images of the canals were acquired.A total of 2 000 images(1 000 intact and 1 000 damaged canal samples)were selected.The dataset was randomly divided in a 4∶1 ratio using 5-fold cross-validation to form training and testing sets(consisting of 1 600 and 400 samples,respectively).Firstly,the optimal radius of the region of interest was identified using the Otsu's thresholding method,followed by feature extraction using pyradiomics.Principal component analysis and the least absolute shrinkage and selection operator algorithm were employed for dimensionality reduction and feature selection,respectively.Subsequently,3 machine learning models(support vector machine[SVM],logistic regression,and random forest)and 3 deep learning models(visual geometry group[VGG],ResNet,and Transformer)were used to classify the ultrasound images.The performance of each model was evaluated using accuracy.Results With a region of interest radius of 230 pixels,the SVM model achieved the highest classification accuracy of 96.25%.The accuracy of the VGG model was only 51.29%,while the accuracies of the logistic regression,random forest,ResNet,and Transformer models were 85.50%,80.75%,80.17%,and 75.18%,respectively.Conclusion For ultrasound images of pedicle screw canals,the machine learning model performs better than the deep learning model as a whole,and the SVM model has the best classification performance,which can be used to assist physicians in diagnosis.

Objective:To evaluate the teaching effectiveness of independent experimental design from students' active learning behavior, and further provide the basis for advancing the reform of functional experimental teaching and teaching quality.Methods:In June 2019, 186 undergraduates (5-year-programme and 8-year-programme) of Xiangya School of Medicine were included in the teaching research. Self-administered questionnaires were applied to characterize students' active learning behavior in independent experimental design education. Spearman rank correlation analysis and Logistic regression analysis were used in the study. SPSS 23.0 was used for descriptive analysis of the data.Results:During the independent experimental design, 85.0%(158/186) of the students thought it was necessary and important to conduct independent experimental design education; 72.6%(135/186) of the students tentatively raised new scientific questions; 97.8%(182/186) of the students actively searched literature; 77.4%(144/186) of the students participated in reply positively. The value of correlation coefficient of actively learning behavior "tentatively raising new science questions" and teaching effectiveness "improving the ability of scientific thinking" was 0.81. And only 42.5%(79/186) of the students agreed that students needed to summarize after reporting.Conclusion:Independent experimental design education is welcomed and widely accepted by students, which has effectively improved the capacity for scientific research and innovation spirit of students. Whether students' active learning behavior can be fully mobilized in the education practice is closely related to the teaching effect. And the cultivation of leadership and leading consciousness still need to be improved.

Objective To explore the application value of telepathological consultation in helping grassroots hospitals.Methods 578 cases of intraoperative telepathology consultation were reviewed,and the accuracy and the timely rate of diagnosis were calculated.The systematic distribution,benign and malignant distribution,and the distribution difference in different primary hospitals were analyzed,so as to evaluate the popularization value of the intraoperative telepathology consultation.Results The accuracy rate of 578 cases of intraoperative telepathology consultation was 99.83％.The timely rate of consultation in 30min was 96.02％,and most reports could be diagnosed in 2 to 5 mins.The source of tissues involved in consultation were thyroid,breast,ovary/fallopian tube and lung.In all cases,24.39％ of the malignant tumors were found.Among the diseases of different systems,the proportion of malignant tumors is the highest in breast diseases,followed by lung,thyroid and ovary.Among the four hospitals with most of the consultations,the rate of malignant tumor in Renmin Hospital of Jianli County was the highest,followed by Renmin Hospital of Yingshan County,Renmin Hospital of Xiaochang County,and Fifth Division Hospital of Xinjiang.Conclusion Intraoperative telepathology consultation can provide accurate and timely expert consultation for grassmots hospitals,avoid the "second operations" of the patients,improve the access of medical treatment for people living in relatively remote areas,solve the shortage of pathologists at the grassroots hospitals,and improve the level of doctors' diagnosis and treatment at the grassroots hospitals,which is worth popularizing and applying in Pathology Department of the grassroots hospitals.

As children are extremely sensitive to the bad taste of medicine,they have poor compliance with the bitter medicine.It is of great importance to develop the approaches of taste masking for the research of paediatric drug formulations.Besides,taste masking technology is one of the main barrier to develop children pharmaceutic preparation.This article provides an overview of the advance in taste masking technology of oral paediatric medicine in recent years,and introduces five types of taste masking technology in terms of drug,preparation and the bitter taste transduction,including principle and characteristics of these approaches,as well as their application in formulations,so as to provide some references for the development of paediatric medicine.

Objective To investigate the urinary patterns in cervical spinal cord injury patients with different courses and degrees of injury.Methods A total of 49 patients with cervical spinal cord injury in the First Affiliated Hospital of PLA General Hospital from January 2014 to October 2016 were enrolled in this study using purposive sampling. Medical data and normal information of patients were recorded. A number of 5 hospitalized patients were interviewed face-to-face, while 44 patients were interviewed by telephone to record the urinary patterns and time of changing urination pattern.Results Indwelling catheter was the main urinary pattern and accounted for 31.0%-61.2% of patients. Patients with different injury degrees had different urinary patterns. Indwelling was the main urinary pattern of patients with complete cervical spinal cord injury and accounted for 42.9%; 14.3% of patients with complete cervical spinal cord injury could urinate by themselves. The main urinary pattern of patients with incomplete injury was self-urination, which accounted for 34.6%; there were 26.9% of these patients with indwelling catheterization.Conclusions The course and degree of injury affect the urinary pattern. Patients with cervical spinal cord injury should have individual urinary patterns to improve their bladder function and restore spontaneous urination so as to improve their quality of life to return to society.

Objective Through the 2003 -2012 epidemic encephalitis B cases analysis ,to study the prevalence of epidemic en-cephalitis B in Shaoguan ,and to provide the scientific basis for the prevention and control epidemic encephalitis B .Methods Active surveillance of suspected cases ,retrospective analysis of laboratory confirmed cases related materials were done .Results There were 47 cases who suffered from epidemic encephalitis B in Shaoguan from 2003 to 2012 ,and 2 death cases occurred .Epidemic en-cephalitis B incidence in years was (0 -0 .531) /10 million .There was a morbidity peak in June and July ,which accounted for 87 .23% of the total incidence ,20 cases occurred in June(42 .55% )and 21 cases occurred in July(44 .68% ) .Men suspected cases in 130 cases ,31 laboratory confirmed cases .Women suspected cases in 86 cases ,16 laboratory confirmed cases .The positive cases of male was more than female .In 47 epidemic encephalitis B cases ,0- <4 years old 6 cases ,4- <7 years old 22 cases ,7- <20 years old 17 cases ,≥ 20 years old 2 cases .Most of the patients were preschool children and students ,accounting for 82 .97% .There were 32 cases with no or uncertain history of vaccination ,accounting for 68 .08% of the total cases .15 cases had history of immunity ,ac-counting for 31 .92% of the total cases .Conclusion Prevention of epidemic encephalitis B should pay more attention to epidemic en-cephalitis B vaccination .Mosquito control work of rural and peri-urban areas should be strengthened .

Objective To observe the clinical effect of MIS-TLIF internal fixation for single-level lumbar disc hernia-tion under X-tube system. Methods Twenty-two cases of patients in our hospital with single-level lumbar disc hernia-tion were treated by MIS-TLIF internal fixation under X-tube system from March 2012 to June 2013. Results The mean operation time was 112 minutes(from 80 to 140 minutes).The mean intraoperative blood loss was 94.8 mL (from 60 mL to 150 mL). Length of hospitalization time was from 4 to 8 days, with the mean time was six days. All the pa-tients were followed up for 3-12 months. ODI scores (79.6±9.5) points preoperatively, and (10.9±4.0) at the last follow-up time postoperatively which indicated statistically significant difference(t=31.19,P<0.01);VAS scores(7.0±1.3) points preoperatively, and (1.1±0.6) at the last follow-up time postoperatively, which also showed statistically significant difference(t=19.78,P<0.01). The results were excellent in 16 cases,good in 4,fair in 2 elevated by Macnab scale at the last follow-up. The excellent-to-good rate was 90.9%. Conclusion The MIS-TLIF treatment under X-tube system can complete nerve roots decompression, fixation and fusion successfully in single-level lumbar disc hernia-tion, which have so many advantages of lower operating damage, less blood loss, faster recovery, safety, and excel-lent clinical results.

Objective To explore the clinical features and causes of misdiagnosis of the patients with acquired deficiency of vitamin K-dependent coagulation factors (ADVKDCF). Methods Retrospective analysis was performed with the data from 62 patients with ADVKDCF for etiological factors, clinical manifestations,laboratory examinations, diagnosis and treatments. Results Among the 62 patients, 51 patients were with unknown causes( subgroup A) and 11 were with clear histories of anticoagulant rodenticide poisoning( subgroup B). The presentations of hemorrhage of the patients varied with hematuria as the most common first symptom,followed by skin, mucosa, muscle, internal organs bleeding (28/62). The most common hemorrhage symptom is hematuria. 35 of the 62 patients had hemoglobin(Hb) levels less than 100 g/L due to blood loss( the lowest level was 32 g/L). Thirty-eight patients were misdiagnosed at the first visit and the median time from hemorrhage manifestation to definite diagnosis was 8 days (range,2 to 192 days). ADVKDCF was mostly misdiagnosed as the urinary system diseases (23/38), followed by hemophilia (8/38). Laboratory examinations showed normal platelet count , throm bin time (TT) and normal fibrinogen(Fg) concentration, but prolonged plasma prothrombin time (PT), activated partial prothrombin time (APTT) and international normalized ration (INR). All of patients received high dose vitamin K ( intravenous vitamin K1 with a initial dose of 20 to 240 mg/d and then oral vitamin K4 maintenance) . The bleeding symptoms disappeared 1 day after treatment and the Hb levels increased dramatically. There were significant differences in PT, APTT and INR of the patients before and after treatment( P ＜0. 01 ). Followed by a median follow - up of 8 months , no patient had severe adverse effects or recurrence. Conclusion The hemorrhage presentations of the patients with ADVKDCF are various. The most common hemorrhage symptom is hematuria. The misdiagnosis rate of ADVKDCF is high with urinary systems disorders as the most common misdiagnosis. Sequential treatment with vitamin K is an effective and safe method to prevent recurrence. Early detection of coagulation function is helpful to reduce misdiagnosis possibility.

Objective To investigate the effect of operation for hyperthyroidism assoiciated with hypokalemic periodic paralysis(HPP).Methods We retrospectively analysed the clinical data of 121 cases of hyperthyoidism associated with HPP.Among them 81 patients received subtotal thyroidectomy after taking Lugol solution for 2 weeks;40 patients received non-operative therapy.Results The plasma potassium,T3,T4,TSH and BMR levels of patients who received subtotal thyroidectomy were all normal 1 week post-operatively,Only 2 patients suffered symptoms of relapse at follow up of 0.5-10 years,with cure rate of 97.5%;8 of the patients who received non-operative therapy recovered,with cure rate of 20.0%.Conclusions Operation for hyperthyroidism associated with HPP could cure HPP and hyperthyroidism simultaneously.The therapeutic efficacy of operation is rapid and stable,and is markedly better than that of non-operative therapy.

Object To develop a capillary GC-MS analytical method for identification and deter- mination of ginkgolide A, B, C and bilobalide (GA, GB, GC and BB) in Ginkgo biloba L. leaves. Methods The leave samples were extracted in ultrasonic bath with ethanol-water (20∶80). The extract was purified by liquid-liquid extraction with ethyl acetate followed by solid-phase extraction on a column mixed with acid Al 2O 3, active carbon and celite. The terpenes were trimethylsilylated by BSTFA (with 1% TMCS) for 60 min at 100 ℃ and determined by GC-MS with HP-5 MS capillary column in the selected-ion monitoring mode. The intense fragment ions were chosen as monitoring ions for quantitative analysis. Cholesterol was used as an internal standard. Column temperature gradient: initial temperature 180 ℃, maintained 1 min, and then increased at 20 ℃/min to 260 ℃, and finally at 2 ℃/min up to 300 ℃, maintained 2 min. Results The retention times of GA, GB, GC and BB were 13.7,14.3,15.3 and 6.8 min, the major fragmentation ions (monitoring) were at m/z 537, 625, 713 and 455 (299), the average recoveries of GA, GB, GC and BB were 102.0%, 99.4%, 96.0%, 96.3%, RSD were 0.54%, 2.40%, 1.98% and 2.43%, respectively. Conclusion This method is repeatable, specific, accurate and easy to operate. It is adoptable for quality and quantity analysis of terpene lactones from G. biloba leaves.