Medical artificial intelligence （AI） is a new type of application formed by the combination of machine learning， computer vision， natural language processing， and other technologies with clinical medical treatment. With the continuous iteration and development of relevant technologies， medical AI has shown great potential in improving the efficiency of diagnosis and treatment， and service quality， but it also increases the possibility of triggering ethical issues. Ethical issues resulting from the clinical application of medical AI were analyzed， including the lack of algorithmic interpretability and transparency of medical AI， leading to information asymmetry and cognitive discrepancies； the concerning status of security and privacy protection of medical data； and the complex and unclear division of responsibilities due to the collaborative participation of multiple subjects in the clinical application of medical AI， resulting in increased difficulty in the identification of medical accidents and clarification of responsibilities. The paper proposed the principles of not harming patients’ interests， physician’s subjectivity， fairness and inclusiveness， and rapid response. It also explored the strategies and implementation paths for responding to the ethical issues of medical AI from multiple perspectives， including standardizing the environment and processes， clarifying responsibility attribution， continuously assessing the impact of data protection， guaranteeing data security， ensuring model transparency and interpretability， carrying out multi-subject collaboration， as well as the principles of being driven by ethical values and adhering to the “human health-centeredness.” It aimed to provide guidance for the healthy development of medical AI， ensuring technological progress while effectively managing and mitigating accompanying ethical risks， thereby promoting the benign development of medical AI technology and better serving the healthcare industry and patients.

Objective:To investigate the biomechanical properties of a self-developed crossed-hug locking plate system in fixation of Vancouver type B1 periprosthetic femur fractures.Methods:Vancouver type B1 periprosthetic femur fractures in clinic were simulated in 3 samples of artificial adult femur produced by Sawbone corporation in USA, including 2 of model 3403 and 1 of model 3447. The fractures were then fixed with our self-developed crossed-hug locking plate system. After the load state of the human body in the upright stance was simulated on an experimental machine, compression tests (with a loading force of 50 to 500 N, and a displacement controlled acceleration of 5 mm/min), compression fatigue tests (with a loading condition of 50 to 500 N sine wave force value, a frequency of 5 Hz, and cyclic loading of 250 times), torsion tests (torque loaded at an torque angle acceleration of 1°/min to 15°/min in clockwise rotation), and torsion failure tests were conducted in sequence.Results:The axial compression tests showed that the displacements in the 3 samples were 0.83 mm, 0.45 mm and 0.41 mm, respectively, leading to no abnormal changes in the crossed-hug locking plate system in all samples. The compressive fatigue tests showed that the displacements in the 3 samples were (0.70±0.05) mm, (0.44±0.01) mm, and (0.42±0.02) mm, respectively, with the maximum displacement change less than 0.13 mm, leading to no abnormal changes in the crossed-hug locking plate system in all samples. The torsion within 4° in the torsion test showed that the maximum torque was 4.73 N·m in sample 1, 7.82 N·m in sample 2, and 7.37 N·m in sample 3. In the torsion failure tests, sample 1 was fractured at the first screw in the distal femoral bone plate, with an ultimate torque of 28.18 N·m. In sample 2, the torque at which the hook started to slide was 16.00 N·m, and the ultimate torque at which the hook broke to cause internal fixation failure was 18.74 N·m. The torque at which the hook started to slide in sample 3 was 20.49 N·m, and the ultimate torque at which the hook broke to cause internal fixation failure was 24.82 N·m.Conclusion:Our self-developed crossed-hug locking plate for Vancouver type B1 periprosthetic femur fractures has achieved the mechanical strengths required in the mechanical tests which simulate human upright load with Sawbone biomechanical test materials.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To observe the correlation analysis between the deep-superficial flow-density ratio (DSFR) and treatment response of macular edema secondary to branch retinal vein occlusion (BRVO).Methods:Forty-eight patients (48 eyes) with macular edema secondary to BRVO from December 2018 to December 2019 in the Department of Ophthalmology of Beijing Hospital were enrolled in this study. There were 29 males (29 eyes) and 19 females (19 eyes), with the mean age of 58.77±10.88 years. All eyes were treated with intravitreal injection of ranibizuma once a month for 3 months, and then treated as needed. According to the central retinal thickness (CRT) 12 months after treatment, the patients were divided into good response group (CRT≤250 μm) and refractory group (CRT> 250 μm). The flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of all subjects was measured by optical coherence tomography angiography. The flow density of DCP and SCP measured at 3 follow-up times was selected and DSFR was calculated. The DSFR was recorded by the Study for the Treatment of Diabetic Retinopathy (ETDRS) -grid and Nine-grid. The flow density of DCP, SCP and DSFR were compared between the two groups by paired t test. At 3 months post-treatment, the efficacy of DSFR in ME treatment response was evaluated according to area under curve (AUC) of receiver operating characteristic. Univariate and multivariate binary logistic regression were used to analyze the factors affecting the response to ME treatment. Results:At 12 months after treatment, there were 27 eyes in good response group and 21 eyes in refractory group. There was no statistical significance in the flow density of DCP ( t=1.804, 1.064, 0.660) and SCP ( t=0.581, 0.641, 0.167) and DSFR ( t=0.393、-0.553、0.474) in all area of response group and refractory group using ETDRS-GRID recording method ( P>0.05). The SCP, DCP and DSFR of the most severe non-perfusion area were (27.10±5.70) %, (28.33±8.95) %, 1.35±0.54 and (27.54±6.70) %, (29.11±0.42) %, 1.01±0.40 in the response group and refractory group, respectively. There was no significant difference in the flow density of DCP and SCP between the two groups ( t=-0.237,-0.340; P>0.05). The difference of DSFR between two groups was statistically significant ( t=2.288, P=0.024). Univariate and multivariate binary logistic regression analysis showed that DSFR in the most severe non-perfusion area was associated with ME response (odds ratio=0.212, 0.085; P=0.027, 0.024). The AUC was used to evaluate the efficacy of DSFR in ME treatment response, the results showed that the AUC was 0.800, P=0.001, Youden index was 1.348, sensitivity was 67.7%, and specificity was 86.7%. Conclusions:DSFR reduction is more common in BRVO secondary to ME patients. DSFR correlates with ME treatment response.

Objective:To evaluate collared and bipolar hemiarthroplasty combined with medial femoral calcar reconstruction in the treatment of senile patients with osteoporotic unstable intertrochanteric fracture.Methods:The data of 28 senile patients with unstable femoral intertrochanteric fracture were retrospectively analyzed who had been admitted to Department of Orthopedics, The First Affiliated Hospital to Zhejiang University of Chinese Medicine from March 2014 to February 2020. They were 8 males and 20 females, aged from 75 to 99 years (average, 81.5 years). All the fractures were low violence injuries due to falls. By the Evans-Jensen classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ and 21 cases of type Ⅴ. All patients were osteoporotic, with a BMD T-score ranging from -4.5 to -2.0. Surgery was performed 2 to 6 days after injury (3.8 days on average). Corail collared femoral stems and bipolar ball heads produced by DePuy company were selected for implantation during surgery. Their fractures were reduced and fixated by titanium wire bundling system or bifilar winding wire bundles. The femoral calcar reconstruction was accomplished by inserting the beak-shaped distal part of the head-neck fracture fragment into the femoral medullary cavity together with the medial side of the stem just under the collar and impacting it to a tight position.Results:The average operation time for this group of patients was 62 min (from 50 to 85 min) and the average intraoperative blood loss 170 mL (from 110 to 320 mL). All the 28 patients were followed up for 10 to 71 months (average, 46 months). Their Harris hip scores averaged 92 points (from 89 to 96 points) at 6 months after operation. Two patients developed intermuscular venous thrombosis in the calf after operation. During follow-up, none of the patients had such complications as deep iliac femoral vein thrombosis, pulmonary embolism, incision infection, or deep prosthesis infection. At the last follow-up, their Harris hip scores averaged 88 points (from 82 to 96 points).Conclusion:For some senile patients with osteoporotic unstable intertrochanteric fracture, collared and bipolar hemiarthroplasty combined with medial femoral calcar reconstruction can achieve fine therapeutic efficacy.

Objective:To compare preoperative portal vein embolization (PVE) using tris-acryl gelatin microspheres (TAGM) versus coils.Methods:From March 2016 to June 2018, 21 consecutive patients with a future liver remnant (FLR) ratio of less than 45% before planned major hepatectomy for malignant or benign liver diseases were enrolled from the First Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital into this study. The patients were divided to receive portal vein embolization (PVE) using TAGM distally and coils proximally (the TC group) and PVE using multiple coils (the CC group). Post-PVE complications, liver function, routine blood tests; FLR hyperplasia, types of liver resection, operation time, intraoperative blood loss, and postoperative complications were compared between the two groups.Results:Eight patients were included in the TC group. There were 4 males and 4 females, with a mean age of (55.3±7.7) years. Of 13 patients included into the CC group, there were 11 males and 2 females, with a mean age of (52.6±11.3) years. There were no significant differences in sex, age, types of hepatic diseases, volume of FLR, ratio of FLR, ratio of standard FLR, types of surgery, operation duration, blood loss, major complications, and liver failure rates between the two groups. All patients in the two groups had successful PVE. The TC group developed effective growth of volume of FLR with one patient who failed to undergo surgery because of tumor progression. In the CC group, four patients failed to undergo liver resection: one patient developed thrombosis of the left branch and main trunk of portal vein; tumor progression occurred in one patient and two patients had insufficient FLR growth. Compared with the CC group, the TC group had a significantly higher volume of FLR hyperplasia [(9.0±2.8) % vs. (5.2±3.8) %, P<0.05], and a faster but insignificant increase in proliferation rate [(11.4±7.1) ml/d vs. (6.9±5.2) ml/d, P>0.05], a greater but insignificant increase in percentage of proliferation [(33.6±20.1) % vs. (20.9±15.1) %, P>0.05]. Conclusions:This study showed that PVE with TAGM plus coils is safe and effective. It induced a better degree of hypertrophy of FLR compared to PVE using multiple coils.

Objective To evaluate the feasibility and efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) followed by selective portal venous embolization (PVE) in patients with marginally resectable hepatocellular carcinoma (HCC).The aim was to find out whether this combined procedure helped to increase the rate of extended radical liver resection.Methods From March 2009 to November 2016,29 patients with HCC which were marginally resectable underwent preoperative TACE combined with PVE were included into this study.All these patients were subsequently assessed to undergo radical hepatectomy.The complications,laboratory results,volume changes of each liver lobe and patient survival were analyzed.Results TACE combined with PVE was successful in all the 29 patients.There were no major complications.After the procedure,the volumes of the tumor and the part of the liver to be resected decreased to certain degree.The remnant liver volume (RLV) increased remarkably.The RLV were (395.4 ±58.7) cm3 and (599.2 ±75.2) cm3 before and after the procedure,respectively.The difference was significant (P ＜ 0.05).19 patients underwent radical hemihepatectomy or trisectionectomy,with a resection rate of 65.5％ (19/29).There were sufficient surgical margins in all the resected tumors.After operation,the 1-,3-,and 5-year survival rates were 58.8％,35.5％ and 17.6％,respectively.Conclusion For HCC patients who had marginally resectable HCC,preoperative TACE combined with PVE efficiently controlled the growth of the tumors,decreased the volume of the liver lobe with tumor,increased the RLV,and made it possible for a planned two-stage radical hepatectomy with sufficient surgical margin and better survival in a significant proportion of patients.

Objective To evaluate the effect of fast-track TKA upon the recovery time and degree of satisfaction of the patients.Methods 208 patients with primary osteoarthritis between 2013 and March 2015 were randomly divided into 2 groups.In fast-track TKA group was established in peri-operative analgesia,blood management,postoperative anticoagulation,surgical skill and mitigation of perioperative stress.In TKA group,conventional surgical management mode was followed.Identical discharge standards were established for patients in 2 groups to evaluate the recovery time.The patients' degree of satisfaction at postoperative 2 weeks was assessed by numerical rating scale (NRS).The degree of satisfaction about acquisition of preoperative information,degree of satisfaction about postoperative analgesia and postoperative function were statistically compared between 2 groups.Postoperative complication,blood transfusion rate,infectious events within postoperative 3 months,thrombosis-related events,re-operation and death were recorded.Results In fast-track TKA group,the mean discharge time was (2.3±1.2) d,significantly shorter compared with (4.7±5.1) d in TKA group.The mean NRS score in fast-track TKA group was 9.8±0.5 and 9.1±1.4 in TKA group.In fast-track TKA group,the mean scores of the degree of satisfaction about acquisition of preoperative information,degree of satisfaction about postoperative analgesia and postoperative function were 27.7±7.3,9.8± 1.7 and 9.6± 1.3,significantly higher than 15.5±10.1,9.2±2.2 and 8.7±1.8 in the TKA group.In fast-track TKA group,postoperative blood transfusion rate was 3.9％,considerably lower than 11.4％ in TKA group.Conclusion Fast-track TKA can shorten the length of hospital stay,not increase the mortality rate and postoperative complication,accelerate the recovery of daily activity and effectively enhance the degree of satisfaction of the patients.

Objective To introduce a new classification system for femoral intertrochanteric fractures and propose classification to assist surgical management.Methods A total of 176 cases of femoral intertrochanteric fractures treated from September 2007 to October 2011 were enrolled in the study.X-ray and three-dimensional spiral CT reconstruction were performed to define fracture shape,location,number of major fragments and displaced direction.As combined with the intraoperative findings and cadaveric anatomical study,the femoral intertrochateric fractures was simulated using a three-dimensional entity of normal proximal femur produced by Mimics 11.1 program.A new classification system for femoral intertrochateric fractures was proposed.Results The new system categorized intertrochateric fractures of the femur into five types (Type Ⅰ,Type Ⅱ,Type Ⅲ,Type Ⅳ and Type Ⅴ) based on the integrity or destruction of the medial column,lateral column and posterior column set and divided on the basis of bone connection of femoral head-neck fracture fragments with the bone in intertrochanteric region.Conclusions The new classification system with introduction of three-column concept is brief and practical and has a clear definition of fracture stability.Besides,the new classification-based treatment is recommended.

Objective To explore the clinical results of total knee arthroplasty (TKA) in the treatment of knees with bony ankylosis in extension.Methods From June 2000 to June 2007,10 patients had knees with bony ankylosis in extension were treated with TKA,including 4 males and 6 females,with an average age of 49 years (range,29 to 63 years).The primary diseases were as follows:ankylosing spondylitis in 3 cases,rheumatoid arthritis in 2 cases,hemophilic arthritis in 1 care,traumatic arthritis in 3 cases and pyogenic arthritis in 1 case.The range of motion (ROM) was 0° in all knees,and the average HSS (the Hospital for Special Surgery) score before operation was 32.5±10.26.Two patients underwent bilateral TKA,and 8 underwent unilateral TKA.Results All patients were followed up for 3 to 10 years (average,5.3 years).The average HSS score was improved to 87.75±6.45 at the last follow-up,and there was significant difference compared with that before operation (t=18.668,P=0.000).The average ROM was improved to 97.08°±11.57°at the last follow-up,and there was remarkable difference compared with that before operation (t=29.063,P=0.000).The postoperative complications included cutaneous necrosis in 2 cases,deep venous thrombosis of lower limb in 1 case,periprosthetic fracture in 1 case,and deep prosthetic infection in 1 case who underwent revised TKA later.The postopertative X-ray showed no looseness of the prostheses.Conclusion TKA through medial parapatellar approach,with dissection of the rectus femoris,secondary osteotomy and soft tissue balance intraoperatively is effective in the treatment of knees with bony ankylosis in extension,which can correct the ankylosed knee deformitis successfully.Combining with the correct rehabilitation exercise,it is possible to improve significantly the function of knee and life quality in these patients.