Hubei 672 Orthopedics Hospital of Traditional Chinese Medicine and Western Medicine

BackgroundEarly and accurate identification of mild cognitive impairment (MCI) is crucial for timely intervention and preventing further cognitive decline. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, portable tool for clinical screening, but its diagnostic accuracy is often constrained by single-paradigm approaches and small sample sizes. To address this limitation, this study aimed to develop and validate an efficient early MCI screening model by integrating large-sample fNIRS data from resting-state and 1-back task paradigms using ensemble machine learning, thereby enhancing the accuracy and reliability of early MCI diagnosis.MethodsA total of 462 right-handed participants (185 MCI patients and 277 healthy controls, aged 58 -87 years) were included in the final analysis after screening, with MCI diagnosis jointly determined by two experienced neurologists based on Petersen’s criteria. fNIRS signals were collected during resting-state and 1-back task sessions; after preprocessing in MATLAB, features were extracted from oxygenated hemoglobin (HbO) signals of both paradigms.ResultsFeature selection was performed via a gradient boosting classifier based on feature importance scores, resulting in 108 selected features. Five classifiers were trained and evaluated using 10-fold cross-validation. The integrated dataset combining resting-state and 1-back task features outperformed the single-paradigm datasets: the Neural Network model on this integrated dataset achieved an accuracy of 86.49%, sensitivity of 94.74%, specificity of 77.78%, and Area Under the Curve (AUC) of 93.49%. In contrast, the Nearest Neighbor model on the resting-state dataset and the Decision Tree model on the 1-back task dataset yielded accuracies of 70.27% and 75.68%, respectively. Group classification using MoCA scores achieved an accuracy of 86.55%, which was comparable to single-paradigm machine learning models but inferior to the integrated model.DiscussionThis study demonstrates the value of a large-sample, data-driven approach and multi-paradigm feature integration in fNIRS-based MCI screening, providing an efficient diagnostic model for clinical application.Clinical trial registrationhttps://www.chictr.org.cn/showprojEN.html?proj=192047.

To systematically evaluate and compare the efficacy and safety of clopidogrel and aspirin, as well as their combination, in patients with chronic coronary syndrome (CCS), and to provide evidence-based support for long-term antiplatelet therapy in stable coronary artery disease. A comprehensive literature search was conducted in CNKI, WanFang, PubMed, Web of Science, and Embase databases from January 1990 to July 2025. Randomized controlled trials comparing clopidogrel and aspirin as monotherapy or in combination in patients with CCS were included. Relative risk (RR) or mean difference (MD) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models according to heterogeneity. Publication bias and sensitivity analyses were performed where appropriate. A total of 24 studies involving patients with chronic coronary syndrome were included. Compared with aspirin monotherapy, clopidogrel monotherapy was associated with a numerically lower incidence of myocardial infarction, although the difference was not statistically significant. No significant difference in the risk of serious bleeding events was observed between clopidogrel and aspirin. Combination therapy with clopidogrel and aspirin was associated with a higher treatment response rate and a tendency toward reduced angina frequency compared with aspirin alone; however, substantial heterogeneity was present, and the observed benefits were mainly confined to subjective or semi-quantitative outcomes. The incidence of common adverse reactions, including gastrointestinal discomfort, dizziness, and headache, was numerically lower in the combination therapy group, but these differences did not reach statistical significance. In patients with chronic coronary syndrome, clopidogrel represents a reasonable alternative to aspirin for long-term antiplatelet therapy, with comparable efficacy and safety. Combination therapy with clopidogrel and aspirin may offer modest improvements in symptom-related outcomes; however, these findings should be interpreted cautiously due to heterogeneity, potential publication bias, and the subjective nature of some endpoints. Individualized antiplatelet strategies based on ischemic and bleeding risk remain essential in stable coronary artery disease. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251108327.

Abstract Background: Transforaminal Endoscopic Lmbar Discectomy (TELD) is widely applied for lumbar degenerative disease(LDD) and satisfactory short-term outcomes have been achieved. However, the mid-term and long-term follow-up of this technique is still lacking.Objective: To retrospectively analyze the mid-term clinical efficacy of TELD for single-level LDD with a minimum of 6-year follow-up.Methods: 75 patients with single-level LDD (lumbar disc herniation, lumbar spinal stenosis) who underwent TELD in our department from December 2014 to December 2015 were observed.Visual analog scale (VAS), Japanese Orthopaedic Association evaluation treatment (JOA) score and Oswestry Disability Index (ODI) were calculated and compared before operation, 3 months after operation, 6 months after operation, 1 year after operation and at the last follow-up. Disc Height (DH), disc range of motion (ROM) and disc degeneration on standard lumbar lateral radiographs before operation and at the last follow-up were determined. Recurrence rate and operation-related complications during follow-up were recorded.Results: 64 cases were included and followed up for 6.4±0.1 years. There were no complications such as infection, epidural hematoma and nerve root injury. There were significant differences in VAS, JOA, ODI between preoperative and postoperative 3 months, 6 months, 1 year and last follow-up (P < 0 01), VAS, JOA, ODI at 3 months after operation were different from 6 months after operation (P < 0 05), and there were significant differences compared with preoperative, 1 year after operation and last follow up (P < 0 01). VAS, JOA and ODI at 6 months after operation were significantly different from those before operation (P < 0.01), but not significantly different from those at 1 year after operation and the last follow-up (P > 0.05). There was no significant difference in DH,ROM and the Pfirrmann grade of intervertebral disc preoperative and the last follow-up. During the follow-up period, 3 patients (4.69%) were recurrent, 1 patient (1.67%) found dural rupture and cauda equina hernia, 13 patients (20.31%) had various degrees of POD, and 3 patients (4.69%) had various degrees of muscle weakness.Conclusion: TELD has a satisfactory mid-term efficacy, and has no significant effect on the DH, the stability of the intervertebral disc space, or on intervertebral disc degeneration. However, as expected, TELD was associated with some complications including recurrent disc herniation and POD.

Closed reduction and percutaneous pinning (CRPP) is a promising treatment for pediatric lateral condyle humerus fractures (LCHFs) displaced >4 mm. However, few studies discussed roles of fracture types on success of CRPP in LCHFs. This study aimed to analyze the impacts of types of LCHFs displaced >4 mm on the success rate of CRPP. We retrospectively reviewed 66 consecutive pediatric LCHFs attempted CRPP at our center. Song, Milch, Jakob, and Weiss classification were used to classify LCHFs. The fracture gap ≤2 mm and step of articular surface ≤2 mm were deemed as a successful CRPP. Otherwise, open reduction and internal fixation (ORIF) would be performed. Different fracture types and preoperative displacement were analyzed for their roles on success rate of CRPP in treating LCHFs displaced >4 mm. Fifty patients met the inclusion criteria were finally included in this study. Results showed that Milch type II LCHFs had a higher success rate of CRPP than type I LCHFs (P=0.03, <0.05). Correlation was found between Milch types and success rate of CRPP displaced >4 mm. No difference was found between Song stage 4 and 5 LCHFs displaced >4 mm in success rate of CRPP (P=0.90, >0.05), also no difference was found in pre-operative displacement between CRPP group and ORIF group. Milch classification is more important than Song classification in the success rate of CRPP when treating LCHFs displaced >4 mm. Milch type II LCHFs are recommended to be treated with CRPP, while Milch type I LCHFs are recommended to be treated with ORIF. The current study confirm Song's initial report that closed reduction can be successful and should be attempted for fractures with such displacement rather than going directly to ORIF. Level III.

Abstract Objective: To analyze the risk factors of cerebrospinal fluid leakage(CSFL) following lumbar posterior surgery and summarize the related management strategies. Methods: A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation(LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor(LST). Data of gender, age, body mass index(BMI), duration of disease, diabete,smoking history, preoperative epidural hormone injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, extubation time, suture removal time, and complications were recorded.Results: The incidence of 115 cases with cerebrospinal fluid leakage,was 3.62% (115/3179).One-way ANOVA showed that gender, body mass index(BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL(P &gt;0.05). Age, type of disease, duration of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery had effects on CSFL(P&lt;0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were significantly affected CSFL(P&lt;0.05), and duration of disease and age of the patients were not significantly affected CSFL (P &gt;0.05).The extubation time of CSFL patients ranged from 7 to 11 days, with an average of 7.11±0.48 days, the extubation time of patients without CSFL was 1-3 days, with an average of 2.02±0.13 days, and there was a statistical difference between the two groups(P &lt; 0.05).The removal time of CSFL patients was 12-14 days, with an average of 13.11±2.67 days, and the removal time of patients without CSFL was 10-14 days, with an average of 12.87±2.19 days, there was no statistically significant difference between the two groups (P&gt;0.05). Conclusion: Type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery.Once appear, CSFL can also be effectively dealt with without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18-6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53-5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%-50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19-associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

A retrospective study was designed to explore the relationship between the satittal spinopelvic alignment in patients with lumbar disc extrusion and spontaneous resorption. From May 2010 to March 2019, referring to NASS evidence-based clinical guidelines, patients with lumbar disc extrusion were enrolled in this retrospective study, according to the degree of herniation size during the follow-up, the patients were divided into two groups: resorption (group R: the herniated disc completely disappeared or the herniation size was grade 1 according to Michgan State University (MSU) classification) and nonresorption (group N: the herniated disc remain unchanged or the herniation size overpass grade 1), spinopelvic parameters (including the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL)) were determined on standing profile radiographs of the lumbar spine and pelvis, and mean values were compared using the multi-factor analysis of variance. This study included 67 patients with lumbar disc extrusion. There were 37 in group R (the average age was 42.6 years), 21 males and 16 females, 13 cases at L 4-5 level and 24 cases at L 5-S 1 level, follow-up 22 months, and 30 in group N (the average age was 40.8 years), 19 males and 11 females, 12 cases at L 4-5 level and 18 cases at L 5-S 1 level, follow-up 21 months, at the follow up time, there symptoms were all satisfactorily relieved. There were no signifcant differences in age, gender, smoking history, chronic medical history, prominent segmnet, MSU classification, follow up time and other baseline conditions between two groups ( P>0.05). At the follow-up, in group R, all 30 cases of sagittal displaced disc disappeared, the herniated disc changed from the initial MSU classification of grade 2 in 19 cases and grade 3 in 18 cases to the post-absorption residual disc, which were limited to grade 1; in group N, 20 cases of sagittal displaced disc reduced to 14 cases, the herniated disc changed from the initial MSU classification of grade 2 in 21 cases and grade 3 in 9 cases to grade 2 in 27 cases and grade 3 in 3 cases. There was no significant difference in spinopelvic parameters between the two groups before the treatment ( P>0.05). At the follow-up, there was no significant difference in PI between the two groups ( P>0.05); the SS and LL in group R were bigger than those in group N, the PT in group R was smaller than that in group N, and the difference was statistically significant ( P<0.05). Compared within the same group, before treatment and follow-up, there were no significant differences in PI, SS and PT in group R, but a bigger LL ( P<0.05); no significant differences in all the parameters in group N were found. Resorption may result in pinopelvic parameter changes, which suggest that the lumbar spine is better at cushioning against load, reducing the disc pressure, and leading to resorption of the herniated disc.

To investigate the effectiveness of total elbow arthroplasty (TEA) with preservation of triceps brachii insertion approach. Between January 2012 and September 2017, 17 patients with elbow disease were treated with TEA with preservation of triceps brachii insertion approach. There were 3 males and 14 females, with an average age of 65.2 years (range, 48-85 years). The injuries located on left elbow in 5 cases and on right elbow in 12 cases. There were 11 cases of distal humerus fracture (AO type C1 in 2 cases and type C3 in 9 cases); the interval between fracture and operation was 3-10 days (mean, 4.1 days). There were 3 cases of osteoarthritis and 3 cases of rheumatoid arthritis, with the disease duration of 2-26 years (mean, 8.7 years). The postoperative elbow function and pain was assessed by Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, respectively. The prosthesis position, heterotopic ossification, and periprosthetic fracture were observed by X-ray films. All incisions healed by first intention. Sixteen patients were followed up 18-69 months (mean, 40.6 months). Intraoperative ulnar nerve injury occurred in 2 cases, and healed after symptomatic treatment. At last follow-up, the MEPS score was 55-100 (mean, 90.3). The results were excellent in 11 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 81.3%. The VAS score was 0-2 (mean, 0.4). X-ray reexamination showed that no polyethylene wear, prosthesis loosening and fracture, abnormal prosthesis position, periprosthetic fracture occurred during the follow-up period, and the prosthesis survival rate was 100%. Heterotopic ossification occurred in 2 and 3 months after operation in 2 cases, respectively. The triceps on approach for TEA are satisfactory for distal humerus fracture, osteoarthritis, and rheumatoid arthritis.