To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To investigate the effect and clinical application value of propofol combined with midazolam on neurological function in patients with acute cerebral hemorrhage undergoing hematoma evacuation.

A total of 100 patients undergoing surgery for acute cerebral hemorrhage admitted to Shenmu Municipal Hospital from January 2022 to December 2024 were enrolled as research subjects, including 56 males and 44 females, aged 42~70 years [(52.44±6.02) years]. The patients were divided into a control group (n=50) and an observation group (n=50) by the random number table method. The control group received anesthesia with propofol alone, while the observation group received anesthesia combined with propofol and midazolam. Differences between the two groups were compared in vital signs [mean arterial pressure (MAP), heart rate (HR)], oxidative stress indicators [malondialdehyde (MDA), cortisol (Cor), norepinephrine (NE)], nerve injury factors [neuron-specific enolase (NSE), S100β protein (S100β)], National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, anesthetic efficacy and safety indicators. Safety indicators contained anesthesia induction time, extubation time, post anesthesia care unit (PACU) stay time, incidence of intraoperative hypotension, dosage of vasoactive drugs, length of intensive care unit (ICU) stay, incidence of postoperative delirium and pulmonary infection.

There was a significant group × time interaction effect for HR and MAP (P<0.05). Simple effect analysis showed no intergroup differences in baseline vital signs (P>0.05). From T₂ to T₄ after operation, HR and MAP in the observation group were significantly lower. Vital signs remained stable throughout the observation period in the observation group, whereas obvious elevations in these indicators were observed in the early postoperative stage in the control group. The levels of MDA, Cor and NE at 48 h after operation were increased compared with preoperative levels in both groups; these indicators at 48 h postoperatively in the observation group were lower than those in the control group at the same time point (P<0.05). Meanwhile, the levels of NSE and S100β at 48 h after operation in the observation group were also significantly lower than those in the control group (P<0.05). Repeated-measures analysis of variance revealed statistically significant intergroup differences in NIHSS scores and mRS scores (both P<0.05). Pairwise comparisons after Bonferroni correction demonstrated that NIHSS and mRS scores at 1 month and 6 months postoperatively were lower than preoperative values in both groups, and scores at 6 months postoperatively were further decreased compared with those at 1 month postoperatively (P<0.05). The NIHSS and mRS scores of the observation group at 1 month and 6 months after surgery were lower than those of the control group at the corresponding time points (P<0.05). In addition, the observation group had shorter extubation time and PACU stay time, along with a lower incidence of intraoperative hypotension and less consumption of vasoactive drugs (P<0.05).

Anesthesia with propofol combined with midazolam in acute cerebral hemorrhage surgery can effectively stabilize patients' vital signs, alleviate oxidative stress response, improve anesthetic efficacy, and facilitate the recovery of neurological function, demonstrating substantial clinical benefits.

To analyze the risk factors for postoperative hypoxemia in Stanford type A aortic dissection (TAAD), construct a risk nomogram model based on risk factors, and validate its efficacy.

A retrospective analysis was conducted on 347 TAAD patients treated in Ningbo Medical Center Lihuili Hospital from February 2019 to May 2025. The patients were divided into a training set of 260 cases and a validation set of 87 cases in a 3∶1 ratio. In the training set, there were 128 males and 132 females, with ages ranging from 22 to 81 years [(51.73±15.93) years]. The hypoxemia group and non hypoxemia group were analyzed based on whether hypoxemia occurred 24 hours after surgery. The clinical data of the two groups were compared, and binary logistic regression was used to analyze the risk factors for postoperative hypoxemia in TAAD patients. A nomogram prediction model was constructed based on risk factors. The predictive value of the model was analyzed using receiver operating characteristic (ROC) curves, and the model calibration was evaluated using Hosmer-Lemeshow goodness of fit test.

The proportions of patients aged ≥50 years, body mass index (BMI) ≥25 kg/m², pericardial effusion, white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and blood ransfusion volume were higher in the hypoxemia group than in the non-hypoxemia group; the cardiopulmonary bypass time was longer in the hypoxemia group (P<0.05). According to binary logistic regression analysis, age≥50 years old, BMI≥25 kg/m², pericardial effusion, high WBC count, high hs-CRP, and prolonged cardiopulmonary bypass are risk factors for postoperative hypoxemia in TAAD patients (P<0.05). The constructed nomogram model has a C-index of 0.863 (95%CI: 0.818-0.909) on the training set and 0.856 after Bootstrap correction, with a difference of only 0.007, indicating a low risk of overfitting; The accuracy of the model is 78%. The C-index of the validation set is 0.842 (95%CI: 0.759-0.942), which is close to the corrected value, indicating good generalization ability of the model.

The predictive model for postoperative hypoxemia in TAAD patients constructed in this article shows good performance and can provide auxiliary predictive value for the occurrence of postoperative hypoxemia in TAAD patients.

To explore the early diagnostic value of soluble growth stimulation expressed gene 2 (sST2) and cardiac troponin I (cTnI) combined with bedside echocardiography for sepsis-induced myocardial depression.

100 sepsis patients admitted to Xiaogan Central Hospital from January 2022 to December 2024 were selected as the research subjects, including 59 males and 41 females, aged 32-70 years [(53.59±4.18) years]. According to the occurrence of myocardial depression, they were divided into a myocardial depression group [(LVEF≤50%) (n=34)] and a non-myocardial depression group [(LVEF>50%) (n=66)]. According to the final prognosis, they were divided into a survival group (n=88) and death group (n=12). All patients underwent serum sST2, cTnI levels measurement and bedside echocardiography examination to analyze the changes in serum sST2, cTnI levels and bedside echocardiography [left ventricular posterior wall thickness in diastole (LVPWd), left ventricular posterior wall thickness in systole (LVPWs)], and to analyze their early diagnostic value using receiver operating characteristic (ROC) curves.

Serum levels of sST2 and cTnI in the myocardial inhibition group were significantly higher than those in the non-myocardial inhibition group (P<0.05); LVPWd and LVPWs levels in the myocardial depression group were significantly higher than those in the non-myocardial depression group, while left atrial stroke volume (LASV), left atrial dilation index (LAEI), and left atrial ejection fraction (LAEF) levels were significantly lower than those in the non-myocardial suppression group (P<0.05). Serum sST2, cTnI, LVPWd, and LVPWs levels in the survival group were significantly lower than those in the death group, while LASV, LAEI, and LAEF levels in the survival group were significantly higher than those in the death group (P<0.05). ROC curve analysis results showed that serum sST2 and cTnI combined with bedside echocardiography has certain diagnostic value for sepsis-induced myocardial depression, and the area under the curve (AUC) of the combined detection was 0.991, with a sensitivity of 93.60% and a specificity of 97.52%.

sST2 and cTnI combined with bedside echocardiography can improve the diagnostic efficacy of sepsis-induced myocardial depression patients.

To investigate the incidence and risk factors of anal fistula after surgery for acute perianal abscess, and to establish and validate a nomogram model for predicting the risk of anal fistula in the early postoperative period.

A total of 144 patients with acute perianal abscess admitted to Xi'an Central Hospital Affiliated to Xi'an Jiaotong University from January 2023 to January 2025 were enrolled as the research subjects, including 104 males and 40 females, aged 21-79 years (mean age 50.77±6.23 years). All patients were categorized into an anal fistula group (n=44) and a non-anal fistula group (n=100) according to whether anal fistula was diagnosed within 3 months after surgery. Clinical data of all patients were collected, including gender, age, body mass index (BMI), smoking history, drinking history, hypertension, constipation, diabetes mellitus, hypertension, abscess size, location and depth, preoperative fever history, preoperative antibiotic use, history of abscess and origin of pathogenic bacteria. Variables with P<0.05 in univariate analysis were included in the multivariable Logistic regression model to identify independent risk factors. A nomogram prediction model was constructed based on statistically significant indicators, and model validation was completed.

The incidence of anal fistula was 30.6% (44/144). There were no statistically significant differences in age, BMI, smoking history, drinking history, hypertension, abscess size, constipation, preoperative fever history, abscess location and preoperative antibiotic use between the anal fistula group and the non-anal fistula group (P>0.05). However, statistically significant differences were found in gender, diabetes mellitus, depth of abscess, pathogenic bacteria origin and history of abscess between the two groups (P<0.05). Logistic regression analysis showed that male gender, diabetes mellitus, depth of abscess, intestinal origin of pathogenic bacteria, and history of abscess were independent risk factors for anal fistula after surgery for acute perianal abscess (P<0.05). The concordance index (C-index) of the nomogram model for predicting the risk of anal fistula after acute perianal abscess surgery was 0.844, indicating good discrimination. The calibration curve was close to the ideal reference line, and the predicted values were generally consistent with the observed values. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.945 (95%CI: 0.915-0.979), suggesting that the nomogram model had favorable predictive discrimination.

Male gender, diabetes mellitus, depth of abscess, intestinal origin of pathogenic bacteria, and history of abscess are independent risk factors for anal fistula after acute perianal abscess surgery. The nomogram model may provide a useful reference for the early clinical identification of high-risk patients and for optimizing treatment decisions, although external validation is still needed.

To investigate the correlation of plasma D-dimer (D-D) and serum oxidized low-density lipoprotein (ox-LDL) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, disease severity and short-term prognosis in patients with acute cerebral infarction (ACI).

A total of 146 patients with ACI admitted to Tongchuan Mining Bureau Central Hospital from October 2021 to October 2024 were enrolled, including 86 males and 60 females, aged 25~76 years [(52.94±7.45) years]. According to the TOAST clssification, patients were divided into five subtypes: large-artery atherosclerosis (LAA), cardioembolism (CE), small-artery occlusion (SAO), stoke of other determined etiology (SOE), and stoke of undetermined etiology (SUE). Plasma D-D and serum ox-LDL levels were compared among different TOAST subtypes. Disease severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and patients were divided into mild (n=51), moderate (n=67), and severe (n=28) groups. The modified Rankin Scale (mRS) was used to evaluate prognosis at 3 months after treatment, and patients were grouped according to their mRS scores. Spearman correlation analysis was performed to analyze the correlations of plasma D-D and serum ox-LDL with disease severity and short-term prognosis in ACI patients.

Plasma D-D level was the highest in the CE subtype, followed by LAA subtype, and the lowest in SAO subtype (P<0.05). No significant difference in D-D level was found between SAO and SUE subtypes patients (P>0.05). Serum ox-LDL level was the highest in LAA subtype, followed by the SAO subtype, then the CE subtype, and the lowest in SUE subtype (P<0.05). Plasma D-D and serum ox-LDL levels increased with the severity of the disease, and both were positively correlated with NIHSS scores (r=0.713 and 0.679, both P<0.05). D-D and ox-LDL levels increased with higher mRS scores, and both were positively correlated with short-term prognosis scores (r=0.802 and 0.749, both P<0.05).

Plasma D-D and serum ox-LDL levels differ among patients with different TOAST subtypes, and both are correlated with disease severity and short-term prognosis in ACI patients..

To evaluate the clinical efficacy and safety of stepwise integrated traditional Chinese and Western medicine therapy versus conventional Western medicine alone in patients with severe pulmonary tuberculosis complicated with respiratory failure.

A prospective randomized controlled trial was conducted in 80 patients with severe pulmonary tuberculosis complicated by respiratory failure admitted to Shaanxi Provincial Tuberculosis Prevention and Treatment Hospital from August 2022 to August 2024, including 46 males and 34 females, aged 31-78 years [(56.35±9.58) years]. Patients were randomly assigned by a random number table method to either the control group or the observation group, with 40 patients in each group. The control group received conventional Western medicine treatment, while the observation group received stepwise integrated traditional Chinese and Western medicine treatment on the basis of the same Western medicine regimen. The study compared the clinical efficacy, time to resolution of clinical symptoms, pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF)], inflammatory cytokines [interferon-gamma (IFN-γ), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)], and the incidence of adverse drug reactions between the two groups.

The total clinical effective rate in the observation group was significantly higher than that in the control group (P<0.05). The time to resolution of clinical symptoms (including fever, cough, dyspnea, etc.) in the observation group was significantly shorter than that in the control group (P<0.05). After treatment, FEV1, FVC and PEF were significantly increased in both groups compared with baseline values, and the increases in the observation group were significantly greater than those in the control group (P<0.05), the serum levels of IFN-γ, IL-6 and TNF-α were significantly decreased in both groups, and the decreases in the observation group were significantly greater than those in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse drug reactions between the two groups (P>0.05), and no severe adverse reactions were observed in either group.

Stepwise integrated traditional Chinese and Western medicine therapy can significantly reduce systemic inflammatory response, effectively relieve clinical symptoms, and improve pulmonary function in patients with severe pulmonary tuberculosis complicated with respiratory failure, with no increase in adverse drug reactions, suggesting a favorable efficacy and safety profile.

To investigate the efficacy of hyperbaric oxygen therapy in patients following minimally invasive evacuation of intracranial hematoma.

A retrospective study was performed on 126 patients with intracerebral hemorrhage admitted to the Department of Neurosurgery, The First People's Hospital of Chun'an County between August 2022 and August 2024, including 82 males and 44 females, aged 40~70 years [(58.17±10.69) years]. The participants were assigned to an observation group and a control group according to whether hyperbaric oxygen (HBO) therapy was administered, with 63 patients in each group. Patients in the control group received minimally invasive hematoma evacuation for intracerebral hemorrhage. The observation group received HBO therapy within 24 hours after surgery. The primary endpoint was the National Institutes of Health Stroke Scale (NIHSS) score at postoperative day 14. Secondary endpoints included the temporal changes in postoperative NIHSS scores, cerebral edema volume, oxidative stress levels [malondialdehyde (MDA)、glutathione peroxidase (GSH-Px), superoxide dismutase (SOD)], and adverse events. Pearson correlation analysis was adopted to explore the correlation between oxidative stress indicators and NIHSS scores at the same time point.

Two-way repeated-measures analysis of variance revealed statistically significant main effects of group, main effects of time, and group-by-time interaction effects for NIHSS score, cerebral edema volume, and oxidative stress indicators including MDA, GSH-Px and SOD (all P<0.05). Simple effect analyses indicated that the NIHSS score, cerebral edema volume and MDA level gradually decreased over time, while GSH-Px and SOD levels gradually increased in both groups. No significant intergroup differences in the above indicators were observed before operation (P>0.0125). At postoperative day 3, 7 and 14, the observation group exhibited lower NIHSS scores, smaller cerebral edema volume and lower MDA levels, as well as higher GSH-Px and SOD levels compared with the control group (all P<0.0125). Correlation analysis showed that the NIHSS score at each time point was positively correlated with the concurrent MDA level, and negatively correlated with concurrent GSH-Px and SOD levels (all P<0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (P>0.05).

Hyperbaric oxygen therapy after minimally invasive hematoma evacuation for intracerebral hemorrhage reduces cerebral edema, decreases oxidative stress levels, and improves neurological function.

To explore and construct a risk prediction model for refractory postpartum hemorrhage in postpartum women and to preliminarily evaluate its predictive efficacy.

A total of 500 postpartum patients who met the inclusion and exclusion criteria and were admitted to Linhai Maternal and Child Health Hospital from January 1, 2024 to January 1, 2025 were selected as the study subjects, aged 20~42 years [(30.71±5.02) years]. They were randomly divided into a training group (n=350) and a validation group (n=150) in a 7∶3 ratio. The incidence of refractory postpartum hemorrhage in the training group was assessed, and patients were divided into a refractory postpartum hemorrhage group (n=32) and a non-refractory postpartum hemorrhage group (n=318). Risk factors for refractory postpartum hemorrhage were identified, and a Nomogram prediction model was constructed. Receiver operating characteristic (ROC) curves were used to measure the predictive accuracy of the model, and clinical decision curve analysis (DCA) was used to evaluate the clinical utility of the model.

There were statistically significant differences between the two groups in history of scarred uterus, placenta previa, placental abruption, placental adhesion/invasion/penetration, coagulation dysfunction, uterine atony, prenatal serum coagulation factor Ⅶ (FⅦ) and fibrinogen (FIB) (P<0.05). Multivariate logistic regression analysis showed that history of scarred uterus, placenta previa, placental abruption, placental adhesion/implantation/penetration, coagulation dysfunction, uterine atony, prenatal FVII≥161 U, and prenatal FIB≥3.0 g/L were independent risk factors for refractory postpartum hemorrhage in women who had given birth (P<0.05). The area under the curve (AUC) of the nomogram model was 0.862 (95%CI: 0.833-0.925) in the training group and 0.834 (95%CI: 0.754-0.887) in the validation group. ROC curve analysis determined an optimal risk probability cutoff of 28%. At this threshold, the sensitivity and specificity were 81.17% and 78.64% in the training group, and 75.33% and 72.54% in the validation group, respectively. DCA analysis showed that when the threshold probability set by clinical decision-makers was 28%, the model had a higher net benefit than the full-intervention or no-intervention strategy, suggesting that it has certain clinical decision-making value.

The occurrence of refractory postpartum hemorrhage in postpartum women is associated with factors such as history of scarred uterus, placenta previa, placental abruption, placental adhesion/implantation/penetration, coagulation dysfunction, uterine atony, FVII, and FIB. Constructing a predictive model can provide a reference for subsequent risk assessment and intervention studies of high-risk groups.

To observe and compare the clinical efficacy differences between the modified single-row enhanced technique (sunglasses loop) repair and the traditional double-row suture bridge repair in the treatment of medium-sized rotator cuff tears, and to provide theoretical basis and technical support for optimizing the rotator cuff repair plan.

Inclusion criteria: preoperative MRI-confirmed supraspinatus tear of three to five centimetres, failed conservative treatment, repairable tendon, and follow-up at least 12 months. Exclusion criteria: previous ipsilateral shoulder surgery, infection, severe arthritis, irreparable defect, etc. According to the inclusion and exclusion criteria, a total of 116 patients with moderate rotator cuff tears who underwent arthroscopic rotator cuff repair in Zhuhai People’s Hospital from May 2022 to May 2024 were selected and divided into the sunglasses loop group (n=61) and the double-row suture bridge group (n=55) according to the surgical methods. All the patients in both groups had MRI examinations before the operation to confirm supraspinatus tendon tears, with the tear range beingthree to five centimeters, and all were unilateral lesions. The observation indicators included the operation time during the surgery, the Constant-Murley shoulder function score and visual analogue scale (VAS) before the operation and at one, three, six and 12 months after the operation, as well as the MRI assessment of healing at 12 months after the operation. Continuous variables comparison performed by independent t test, categorical variables analysis used chi square test.

Both groups showed significant improvement in Constant and VAS scores postoperatively (paired t test, P<0.05). The sunglasses loop group had significantly higher Constant scores at three, six and 12 months than the double-row suture bridge group (t=3.39, 2.69, 2.86, all P<0.01), and significantly lower VAS scores (t=-2.48, -2.63, -2.80, all P<0.05). Operation time was significantly shorter in the sunglasses loop group (t=-10.14, P<0.001). Postoperative MRI showed a complete healing rate of 88.5% in the sunglasses loop group, which was superior to 76.4% in the double-row suture bridge group.

For medium-sized rotator cuff tears, the modified single-row enhanced technique (sunglasses loop) shows shorter operation time, better mid-term functional and pain scores, and a higher imaging-documented healing rate compared to the traditional double-row suture bridge repair, it may provide an effective alternative in clinical practice. This conclusion is derived from a retrospective analysis and warrant further validation through well-designed prospective, randomized controlled studies to confirm its efficacy and superiority.

To analyse the effect of foot and ankle functional trainer combined with visual feedback balance function training in postoperative motor ability of elderly hip fracture patients based on propensity score matching (PSM).

From December 2022 to June 2024, 120 elderly patients with hip fractures who were admitted to Xuzhou Central Hospital were selected as the research subjects. Inclusion criteria: (1) age ≥60 years; (2) clinically diagnosed with hip fractures through imaging; (3) received surgical treatment for hip fractures during their hospital stay. Exclusion criteria: (1) pathological fractures caused by tumors, hyperparathyroidism, etc.; (2) concurrent fractures in other parts or previous hip surgeries; (3) severe neurological diseases or dementia; (4) incomplete clinical data. The patients were divided into the combined group (n=52) and the control group (n=68) based on different training methods. After 1∶1 matching using PSM, 46 patients were in each group. Among them, the combined group received combined training with a foot and ankle functional trainer and visual feedback balance function training, while the control group received training with a single foot and ankle functional trainer. The differences in the lower limb part of the Fugl-Meyer motor function rating scale (FMA-L), Harris hip fuction score (HHS-F), and Berg balance scale (BBS) before and after treatment were compared between the two groups. Count data were expressed as the number of cases (n) and rate (%), and chi square test was performed; for data that met normal distribution, they were expressed using and independent sample t test was used for group comparison.

After PSM, there was no statistically significant difference in the baseline data between the two groups (all P>0.05). After eight weeks of intervention, the FMA-L scores of both groups were higher than those before the intervention, and the combined group (33.1±3.1) points were higher than the control group (22.0±3.0) points (t=17.448, P<0.05); the HHS-F scores of both groups were higher than those before the intervention, and the HHS-F score of the combined group (85±5) points and its excellent rate (89.1%) were higher than those of the control group (82±5) points, (78.3%) (t=2.788, P<0.05); the BBS scores of both groups were higher than those before the intervention, and the combined group was (45.5±3.5) points higher than the control group (33.8±3.2) points (t=16.666, P<0.05).

Foot and ankle functional trainer combined with visual feedback balance function training can effectively improve the postoperative motor ability as well as balance function of elderly hip fracture patients, and PSM analysis supports the reliability of its effect, which has clinical promotion value.

To investigate the effect of esketamine on postoperative cognitive function in elderly hip arthroplasty patients.

This prospective study enrolled 114 elderly patients who underwent hip replacement surgery at Chengdu Western Hospital between December 2020 and December 2022. Inclusion criteria: age >60 years, American Society of Anesthesiologists (ASA) classification Ⅱ to Ⅲ, and undergoing unilateral hip replacement surgery. Exclusion criteria: severe cardiac, hepatic or renal insufficiency; history of allergy to anesthetic agents; severe psychiatric or neurological disorders; and long-term use of sedatives, anticoagulants, or similar medications. The patients were randomly assigned to two groups using a random number table, the control group and the intervention group with 57 patients in each. The control group received anesthesia with an equivalent volume of normal saline, while the intervention group received anesthesia with esketamine. Cognitive function was assessed using the mini-mental state examination (MMSE). Repeated-measures analysis of variance (ANOVA) was used to compare MMSE scores between the two groups on the day before surgery and on one, three and seven days after surgery; independent-sample t test was used to compare postoperative recovery outcomes (time to respiratory recovery, time to eye opening, time to first ambulation, and length of hospital stay) between the two groups; repeated-measures analysis of variance was used to compare heart rate (HR), mean arterial pressure (MAP), and Ramsay sedation scores between the two groups at five minutes before anesthesia induction (T0), at the time of induction (T1), one minute after intubation (T2), one minute after skin incision (T3), and at the end of surgery (T4). Independent-sample t test was used to compare stress response indicators between the two groups on the day before surgery and the day after surgery; and chi square test was used to analyze the incidence of adverse reactions in the two groups.

The MMSE score of the study group was significantly higher than that of the control group on the first, third and seventh day after operation (t=9.394, 10.719, 6.352, all P<0.05). There was no statistically significant difference between the two groups in respiratory recovery time, time to open eyes and time to get out of bed for the first time (all P>0.05). Compared with the control group, the hospitalization time of the study group was significantly shorter (t=2.994, P<0.05), and the postoperative delirium rate of the study group (8.8% vs 29.8%) was significantly lower (χ²=8.111, P<0.05). Ramsay sedation score in the study group was significantly higher than that in the control group at T1, T2, T3 and T4 (t=7.363, 6.062, 16.187, 15.735, all P<0.05). The levels of epinephrine, norepinephrine, factor-α (TNF-α), C-reactive protein (CRP), and interleukin (IL) -6 were lower in the study group than in the control group at one day after operation (t=6.063, 3.865, 2.582, 9.083, 2.810, all P<0.05). The incidence of adverse reactions between the study group and the control group (40.3% vs 38.6%) was not statistically significant (P>0.05).

The application of esketamine in elderly patients with hip arthroplasty can effectively reduce the stress response, improve the sedation effect, reduce the postoperative cognitive impairment, and promote the early recovery of patients.

To investigate the associations of six-degree-of-freedom (6-DOF) continuous gait characteristics of the hip, knee, and ankle joints and dual-task cost (DTC) with fall risk in hospitalized older adults under single-task walking and dual-task walking (DTW) conditions with different cognitive loads.

A total of 156 older patients admitted to Taikang Xianlin Drum Tower Hospital, Nanjing, from May 2024 to June 2025 were enrolled. Patients aged ≥60 years who were conscious, able to walk independently for >10 m, and willing to participate were included. Patients who were unable to complete the walking tests because of severe trauma or other conditions, whose falls were caused by external violence or acute diseases, or who declined participation were excluded. Demographic characteristics and lower-limb six-degrees of freedom gait data were collected at baseline during single-task walking and three DTW conditions, including (100-1) DTW, (100-7) DTW, and digit-memory DTW, and DTC was calculated. Falls were recorded during a one-year follow-up. Depending on data distribution, between-group comparisons were performed using the independent-samples t test or Mann-Whitney U test. Continuous six-degrees of freedom gait curves were compared using one-dimensional statistical parametric mapping (SPM1D), and receiver operating characteristic analysis was used to evaluate the discriminative ability of DTC for fall risk.

Among the 156 patients, 46 experienced falls, corresponding to a fall rate of 29.5%. During single-task walking, no significant between-group differences were observed in gait speed (t=0.342), gait cycle (Z=0.312), step length (Z=0.734), or cadence (t=0.354) (all P>0.05). Under all three DTW conditions, the fall group showed lower gait speed, step length, and cadence and a longer gait cycle (all P<0.05). DTC was significantly higher in the fall group during (100-1) DTW, (100-7) DTW, and digit-memory DTW (t=3.885, 4.221, and 5.112, respectively; all P<0.001). Analysis of the six-degrees of freedom gait curves showed reduced upward displacement of both knees in the fall group. The minimum SPM{t} values for the left knee during single-task walking, (100-1) DTW, (100-7) DTW, and digit-memory DTW were −4.3, −4.7, −4.6, and −5.6, respectively, while those for the right knee were −2.5, −3.7, −4.7, and −5.2, respectively (all P<0.01). Right-knee extension angles were greater in the fall group, with corresponding maximum SPM{t} values of 4.6, 5.2, 6.1, and 6.3, respectively (all P<0.05). Under DTW conditions, ankle extension angles were greater in the fall group during several phases of the gait cycle; the maximum SPM{t} values were 3.7 for the left ankle and 5.8 for the right ankle during (100-1) DTW, 5.0 for the right ankle during (100-7) DTW, and 4.1 for the right ankle during digit-memory DTW. In addition, the right-hip abduction angle was greater in the fall group during 7%–73% of the gait cycle in (100-7) DTW [maximum SPM{t}=2.93, P<0.01] and during 8% to 71% of the gait cycle in digit-memory DTW [maximum SPM{t}=2.89, P<0.01]. During digit-memory DTW, the left-knee abduction angle was greater during 67%–94% of the gait cycle [maximum SPM{t}=2.16, P=0.014]. The left-ankle adduction angle was also greater during 26%–65% of the gait cycle in (100-1) DTW [maximum SPM{t}=4.40] and during 26% to 32% and 40% to 65% of the gait cycle in (100-7) DTW [maximum SPM{t}=4.20].

Compared with single-task walking, dual-task walking may further reveal gait abnormalities in older patients at risk of falls, characterized by deterioration in conventional gait parameters, increased DTC, and altered 6-DOF movement patterns of the hip, knee, and ankle joints during specific phases of the gait cycle. Continuous 6-DOF gait analysis combined with DTC may provide objective kinematic evidence for identifying fall risk in hospitalized older adults.