Volume 101 ·  Issue 37 ·  2021

As we know, benign paroxysmal positional vertigo is a peripheral vestibular disorder,while vestibular migraine is a central vestibular disease. Although they are two different independent diseases, patients often choose to consult otolaryngology and neurology. The clinical manifestations of some patients with these two diseases are similar and the diagnosis is easy to be confused, but the treatment methods are completely different, and incorrect treatment methods will inevitably affect the curative effect and prognosis. Vestibular migraine is characterized by a diversity of clinical manifestations and signs, and the migraine symptoms of some patients do not match with the vestibular symptoms. There are 30% of vestibular migraine patients who showed isolated paroxysmal vertigo/dizziness and nystagmus, which is easily confused with benign paroxysmal positional vertigo and needs to be identified. Under the framework of the international classification of vestibular diseases, according to the new guideline of nystagmus examination and classification issued by Barany Association and new diagnostic criteria of two diseases, differential diagnosisof benign paroxysmal positional vertigo from vestibular migrainecan make up for one-sided understanding caused by the specialization of disciplines, improve thediagnosis and treatment of vestibular diseases, and thus reduce the misdiagnosis and mistreatment.

Ankle sprains are a common cause of morbidity in the general and athletic population. The majority of sprains involve the lateral aspect of the ankle, affecting the anterior talofibular ligament. However, the extent and categories of injury will depend upon the mechanism of injury. The ankle injury caused by ankle sprain is not only the injury of lateral collateral ligaments, but also chondral or osteochondral lesions of the talus, anterior ankle impingement, posterior ankle impingement and so on. In addition to the involvement of ankle joint, ankle sprain often leads to the injury of subtalar joint and transverse tarsal joint, even stress fracture, special part fracture or tendon soft tissue injury; multiple injuries often coexist. In clinical work, we should pay more attention to it.

Chronic ankle instability is a chronic sports injury disease characterized by recurrent sprains, feeling of instability, pain, swelling and other symptoms after an initial sprain. Research on the pathological mechanism of chronic ankle instability still cannot explain the diversity of symptoms. In the past, the surgical indications for chronic ankle instability only emphasized mechanical joint laxity. However, most patients with chronic symptoms after a lateral ankle sprain may not have a typical complaint of mechanical instability. More patients presented with persistent pain or functional instability as the chief complaint. Surgical treatment also has a certain effect on the symptoms of functional instability, but the surgical indications of functional instability are mainly based on subjective symptoms. At present, there is a lack of objective indicators for surgery, which is still controversial. Further in-depth research on the mechanism of chronic ankle instability is needed to guide the formulation of diagnosis and treatment strategies.

Ankle sprain is the most common sports injury disease, and some patients will eventually develop chronic lateral ankle instability and need surgical treatment. There are many surgical treatments for this disease, including prosthetic surgery and reconstructive surgery. In order to standardize the surgical treatment of chronic lateral ankle instability, this expert consensus is compiled based on evidence-based medicine and discussed by some experts from the Foot and Ankle Science Group of Sports Medicine Physician Branch of Chinese Medical Doctors Association and the Foot and Ankle Professional Committee of Sports Medicine Branch of Chinese Medical Association, which can be used as a reference for orthopedics, sports medicine and foot and ankle surgeons in China in clinical work. The consensus includes: preoperative education of patients, surgical indications, anatomical repair surgery, non-anatomical reconstruction surgery, anatomical reconstruction surgery, arthroscopic surgical technique, necessity of calcaneofibular ligament repair/reconstruction, complication treatment, surgical treatment of athletes, surgical treatment of ligament relaxation, and evaluation of surgical outcome.

Cardiac troponin is a specific marker of cardiomyocyte injury, and it is the first biomarker of choice for the diagnosis, risk stratification, treatment and prognosis of acute coronary syndrome. This consensus expounds the latest progress of troponin and the current application requirements in China from both experimental and clinical perspectives. Including the performance standard and classification definition of cardiac troponin detection, performance verification and quality control requirements, standardization of result report, influencing factors and standardization of detection, and the diagnosis and differential diagnosis process of acute myocardial infarction suitable for different sensitivity troponin detection methods, as well as the interpretation of troponin results in different clinical application scenarios are given. This consensus emphasizes that both testing and clinical practice are indispensable in the application of troponin, and only in-depth communication between the two aspects can maximize the application value of troponin.

Acquired immunodeficiency syndrome (AIDS) -related tuberculosis is one of the most common opportunistic infections and an important cause of death in AIDS patients. Pulmonary tuberculosis associated with acquired immunodeficiency syndrome has low immunity, often atypical clinical manifestations, and is very difficult to diagnose. Imaging plays a crucial role in its diagnosis. Therefore, in order to standardize its examination, improve the level of imaging diagnosis, and combine the methodological requirements of evidence-based medicine for guidelines and standards, many experts in infection and inflammation radiology, tuberculology and statistics jointly participated in writing and formulating the imaging diagnostic criteria of AIDS-related tuberculosis. Patients with clinical symptoms of pulmonary infection are subjected to further chest X-ray or CT if they test positive for human immunodeficiency virus (HIV). When there are intrapulmonary lesions and/or hilar and mediastinal lymphadenopathy, AIDS-related tuberculosis is suspected; If the intrapulmonary imaging shows multi-area lymph node enlargement in the mediastinum or hilum, diffuse miliary grains and nodules of different sizes are randomly distributed in both lungs, and one of the imaging manifestations above exudative lesions is polymorphic, multilobar and multisegmental lesions, or pleural effusion, the imaging diagnosis is AIDS-related pulmonary tuberculosis. Further laboratory or pathological tests were performed for suspected or imaging cases, and if one positive test was found, the diagnosis was confirmed as AIDS-related tuberculosis.

To further clarify the mid-and-long term follow-up results of self-designed tibial periosteum-bone complex transplantation in the treatment of Hepple V osteochondral lesion of the talus(OLTs).

The clinical data of 30 patients with Hepple V OLTs who received treatment in the Sports Medicine Center of the First Affiliated Hospital of Army Military Medical University from October 2011 to January 2019 were analyzed. There were 19 males and 11 females with a mean age of (40±11) years. Patients were treated with autogenous tibial periosteum-bone complex transplantation and were followed up for at least 2 years. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale score (VAS) of pain, the simplified symptomatology evaluation (SSE) and imaging results before the operation and at the follow-up were recorded and compared.

The cohort were followed-up for a mean of 63.9 months (range 24-110 months). Twenty-nine (96.7%) patients were satisfied with the curative effect. The FAOS score was improved from 53.5±6.2 preoperatively to 88.4±6.6 at the final follow-up (P<0.001). The AOFAS ankle-hindfoot scale improved from 61.6±8.2 preoperatively to 90.8±6.8 at the last follow-up (P<0.001). The VAS score decreased from 4.3±0.2 preoperative to 0.7±0.7 at the last follow-up (P<0.001). The SSE score was poor in 14 cases (46.7%), average in 16 cases (53.3%) before the operation; and it was excellent in 23 cases (76.7%), good in 6 cases (20%), average in 1 case (3.3%) at the last follow-up. Imaging examination showed cystic change cure rate was 83.3%, cartilage defects were completely infilled with repair tissue, which didn′t show any signs of degeneration. However, repair tissue showed varying degrees of heterogeneous signal compared to the normal articular cartilage.

The autograft of tibial periosteum-bone complex transplantation is a safe and feasible method for the treatment of osteochondral lesion of the talus in Hepple V type, with good mid-and-long term clinical effect.

To investigate the outcomes and factors influencing postoperative return-to-sport of patients with chronic ankle instability (CAI) underwent all-inside arthroscopic lateral collateral ligament repair.

Patients with CAI treated at Huashan Hospital of Fudan University from January 2017 to August 2019 were retrospectively recruited. Preoperative and postoperative Tegner and Karlsson scores were evaluated and compared, and a multivariate Cox regression model was applied to explore factors influencing postoperative return to desired sports postoperatively.

A total of 81 patients with CAI treated by all-inside arthroscopic lateral collateral ligament repair were assessed, including 44 males and 37 females with a mean age of (32.7±9.9) years. Karlsson scores (M(Q₁, Q₃)) increased from 55.0 (40.0,65.0) preoperatively to 90.0 (85.0,95.0) postoperatively (P<0.01), while Tegner scores increased from 3.0 (1.0,4.0) preoperatively to 5.0 (4.0,6.0) postoperatively (P<0.01). Sixty patients returned to their desired sports with a median return-to-sport time of 9.0 months. Multivariate Cox regression analysis showed that higher age (HR=0.95, 95%CI: 0.92-0.99, P<0.01) and lower preinjury activity levels (HR=1.43, 95%CI: 1.10-1.85, P<0.01) were independent factors affecting postoperative return-to-sport. The one-year postoperative return-to-sport cutoff scores were 37 years old and a Tegner score of 4, respectively.

The all-inside arthroscopic lateral collateral ligament repair procedure can achieve good short-term outcomes for patients with CAI, permitting a high incidence of postoperative return-to-sport. Higher age and lower pre-injury activity levels are independent factors hindering postoperative return-to-sport.

To study the specific alignment and structure of cancellous bone within the talus in order to understand the mechanism of force transmission within the bone and to provide some theoretical basis for the repositioning of talar fractures and the design of prostheses.

In January 2020, a total of 40 adult talar bone specimens were scanned by Micro-CT in 20 pairs obtained from the Department of Orthopedics of Tianjin Hospital. The bone volume fraction, bone surface area fraction, trabecular thickness, number of trabeculae, trabecular pattern factor of the head, neck and body of the talus were calculated, and the differences in each parameter were compared between different parts of the same side and different sides of the same part, respectively. The talus was cut into 2 mm thick slices in the coronal, sagittal and horizontal planes using a hard tissue slicer, and the slices were then scanned using high-resolution X-rays to describe the bone structure.

There were no statistically significant differences between the medial and lateral talar and right and left side in lateral trabecular bone volume fraction, bone surface area fraction, trabecular thickness, trabecular number, trabecular pattern factors (all P>0.05). The number of trabeculae in the talar head, neck and body was 1.608±0.150, 1.639±0.142 and 1.749±0.159, respectively; trabecular thickness (μm) in the talar head, neck and body was 0.378±0.054, 0.370±0.053 and 0.331±0.062, respectively; and the trabecular pattern factors (mm^-1) in the talar head, neck and body was -0.407±0.699, -0.478±0.848 and -1.029±0.851, respectively. There were significant differences between talar head, neck and the talar body trabeculae in terms of the number of trabeculae, trabecular thickness,trabecular pattern factor parameters(all P<0.05). The structure of the talar body trabeculae was found to consist of plate trabeculae arranged vertically parallel to each other in the coronal, sagittal and horizontal planes. The talar neck trabeculae were twisted, external-superior to internal-inferior reticular plate structure that travelled posteriorly and anteriorly, and the talar head trabeculae consisted of similarly parallel aligned semi-arc-shaped external-superior and internal-inferior trabeculae.

The talar trabeculae are clearly directional and functional, so anatomical reduction should be achieved after the fracture; at the same time, the design of the talar prosthesis should take into account the stress distribution and direction of the prosthesis during walking and standing.

To investigate the effect of simultaneous bone marrow stimulation in the treatment of osteochondral lesions of the talus (OLTs) on arthroscopic repair of anterior talofibular ligament.

The clinical data of 33 patients with ankle instability treated by operation in Sun Yat-Sen Memorial Hospital from January 2018 to December 2019 were retrospectively analyzed. There were 20 males and 13 females with a mean age of (31±9) years. According to the type of surgery, the patients were divided into two groups: ligament repair group (arthroscopic anterior talofibular ligament repair) and bone marrow stimulation group (arthroscopic anterior talofibular ligament repair+talus microfracture). Visual analogue scale (VAS), American Orthopedic Foot And Ankle Society (AOFAS) score, time to return to work and time to return to sport were compared between the two groups.

In the ligament repair group, the preoperative VAS score and the AOFAS score was 5.0±1.9 and 72.4±9.0, respectively, and it was 1.1±1.6 and 95.5±5.2 at the last follow-up, respectively. In the bone marrow stimulation group, the preoperative VAS score and the AOFAS score was 5.8±1.9 and 64.8±12.6, respectively, and it was 1.8±1.5 and 93.1±5.6 at the last follow-up, respectively. The scores of VAS and AOFAS were significantly improved in both groups after the operation, but there was no significant difference between the two groups (both P>0.05). There was no significant difference in time to return to work and return to sport between the two groups (bothP>0.05).

When repairing the anterior talofibular ligament under arthroscopy, simultaneous bone marrow in the treatment of osteochondral lesions of the talus does not affect the postoperative functional recovery and the time to return to work/sport, and satisfactory clinical results also can be obtained.

To determinate the block range of lumbar erector spinal plane (ESPB), and investigate the efficacy of ESPB in lumbar spine surgery.

Forty patients who underwent posterior lumbar fusion in the Second Affiliated Hospital of Wenzhou Medical University from November 2019 to August 2020 were randomly divided into two groups (with n=20 in each group) using the random number table: the experimental group (group E) and control group (group C). All the patients received ultrasound-guided bilateral ESPB with 20 ml of 0.375% ropivacaine (group E) or equal volume of normal saline (group C) on each side before induction of general anesthesia. The range of weakened temperature sense in each patient was measured at 10 min, 20 min and 30 min after ESPB, respectively. Dosage of analgesic drug, visual analog scale (VAS), and incidence of adverse events were recorded and compared between the two groups.

In group E, the dermatomal distribution and area of weakened temperature sense at 10 min, 20 min, 30 min after ESPB were T9-S1 (222±16) cm², T8-S2 (352±22) cm², T8-S3 (481±24) cm², respectively. The intraoperative dosage of remifentanil in group E was (0.76±0.02) mg, which was significantly lower than that of group C (0.97±0.06) mg (P<0.05). Oxycodone consumption in group E at 0-12 h and 12-24 h after surgery was (4.9±0.4) mg and (8.4±1.2) mg, respectively, which were lower than those in group C [(14.5±2.4) mg and (19.3±2.4) mg, respectively] (bothP<0.05). The VAS during rest and movement within 24 h after operation in group E were significantly lower than those in group C (bothP<0.05). The passive exercise in bed in group E started at (3.3±0.3) h postoperatively, which was earlier than that in group C (4.6±0.3) h (P<0.05).

The blocking effects of T12-S1 segment after ultrasound-guided lumbar ESPB is definite, which can effectively decrease the amounts of analgesics during and after the lumbar fusion surgery, reduce postoperative rest and exercise VAS score, and contribute to a rapid recovery of the patients.

To investigate the current status and problems of CD34⁺ cell enumeration in clinical laboratories and provide suggestions for the development of quality improvement programs.

A total of 101 laboratories participating in the national external quality assessment program of CD34⁺cell enumeration were surveyed. Questionnaires and quality assessment materials were distributed to collect information on assay methodology and testing results. Quality control requirements for CD34⁺cell enumeration were determined according to the international guidelines, and the compliance of the surveyed laboratories was analyzed. Testing results were analyzed in groups and compared with the College of American Pathologists (CAP) quality assessment data.

A total of 97 laboratories returned the questionnaires and 99 laboratories returned the results of quality assessment materials. The questionnaire data showed high compliance rates of quality control requirements such as gating protocols, pipetting methods, and the number of cells acquired (92.8%, 83.9%, and 82.5% respectively). However, these laboratories had relatively low compliance rates such as the use of whole blood quality control materials for internal quality control, selection of erythrocyte lysing reagents, sample processing method, whether to report absolute count results, and quality control of equipment (5.2 %, 28.9%, 39.2%, 46.4%, and 55.7%, respectively). Testing results demonstrated that the coefficient of variation (CV) of percent counts was similar to the CAP quality assessment data, but theCV of absolute counts was greater than the CAP quality assessment data.

Clinical laboratories have poor compliance with some quality control requirements and the variability of absolute count results between different laboratories is not satisfactory. Therefore, it is recommended that clinical laboratories should strengthen the training related to the quality control of CD34⁺cell enumeration, especially the absolute counting.

To investigate the correlation between resilience and cognitive function in patients with schizophrenia.

Fifty-nine patients with first-episode schizophrenia and 86 healthy controls were enrolled. Patients with schizophrenia were enrolled from the psychiatric outpatient and inpatient Department of the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to January 2020, while healthy controls were recruited through advertising. The levels of resilience and cognitive function were compared between the two groups.Meanwhile, the partial correlation analysis of resilience and cognitive function of the two groups was performed.

There was no statistically significant difference in gender, marriage and age between the two groups (all P>0.05), and there were 39 males and 20 females with an average age of (23.8±7.4) years in the schizophrenia group, while 47 males and 39 females with an average age of (22.9±4.7) years in the healthy control group. However, there was a significant difference inyears of education between the two groups (P<0.05). The total score of resilience [(56.9±16.7) vs(68.0±14.4)] and scores ofthree factorsin patients with schizophrenia were significantly lower than that in healthy controls(allP<0.05). The total score of MATRICS Consensus Cognitive Battery (MCCB)[(23±12) vs (42±11)] and each subscale score in patients with schizophrenia were significantly lower than that in healthy controls(allP<0.05). Partial correlation analysis showed that the total score of resilience and tenacity were correlated with symbol coding of schizophrenia(partial correlation coefficients were 0.286, 0.289, respectively, bothP<0.05). The total score of resilience and the scores of tenacity, strength and optimism were all correlated with emotion management ability of schizophrenia(partial correlation coefficients were 0.334, 0.271, 0.382, 0.308, respectively, allP<0.05). In the healthy controls, the total score of resilience, tenacity and optimism were correlated with symbol coding(partial correlation coefficients were 0.268, 0.225, 0.291, respectively, allP<0.05). Strength and optimism were correlated with Hopkins verbal learning test (HVLT)(partial correlation coefficients were 0.268, 0.225, respectively, bothP<0.05). Strength was correlated with spatial span, continuous performance test(partial correlation coefficients were 0.244, 0.217, respectively, bothP<0.05). The total scores of resilience and tenacity, strength and optimism were correlated with emotional management ability(partial correlation coefficients were 0.306, 0.230, 0.286, 0.289, respectively, allP<0.05), while the total scores of resilience, strength and optimism were correlated with the total score of MCCB(partial correlation coefficients were 0.291, 0.359, 0.287, respectively, allP<0.05).

The current study suggests that resilience and cognitive function of patients with first-episode schizophrenia areimpaired significantly. Resilience in patients with schizophrenia isrelated to partial neurocognitive function and emotion management ability in social cognitive function.

To explore the effects of gut microbiota and the serum level of folicacid on psychiatric symptoms in first-episode, drug-free schizophrenic (SCZ) patients.

A total of 100 first-episode, drug-free SCZ patients (SCZ group) from the First Affiliated Hospital of Zhengzhou University and 90 demographically matched healthy individuals (healthy control group) were enrolled. The serum level of folic acid was measured by the electrochemical luminescence method.Positive and Negative Syndrome Scale (PANSS) was used to assess the psychiatric symptoms and Matrics Consensus Cognitive Battery (MCCB) was used to evaluate cognitive function. Bacterial DNA was extracted from the fecal samples for high-through put sequencing of the 16S rRNA.The effects of gut microbiota and folic acid on the psychiatric symptoms and cognitive function in SCZ patients were explored.

A total of 41 males and 59 females, with an age of (22.6±8.2) years were included in the patient group, and 32 males and 58 females with an age of (23.0±3.0) years were included in the healthy control group. The fasting folic acid level inserum of the SCZ group was lower than that of healthy control group [6.92(4.98, 8.49) μg/L vs 8.93(7.13, 13.37) μg/L,P<0.001]. The relative abundance ofgenus Bifidobacterium[0.005(0.003, 0.013) vs 0.014(0.004, 0.031)] and genus Bacteroides[0.015(0.001, 0.091) vs 0.083(0.029, 0.193)]was lower in the SCZ group than that of the healthy control group (both P<0.001). In comparison with the healthy control group, scores of cognitive function in the seven domains were significantly lower in the SCZ group (allP<0.05). In the patient group, the serum level of folic acid was negatively related to the negative symptom score(r=-0.378, P<0.001), but had a positive correlation with the score of speed of processing (r=0.310, P=0.011).In the SCZ group, the relative abundance of the genus Bifidobacterium was positively correlated with the serum level of folic acid (r=0.374,P<0.001) and the score of speed of processing(r=0.330,P=0.003) respectively, but was negatively correlated with the general psychopathology score (r=-0.326, P=0.001). The results of multiple linear regression analysis showed that the interaction term between folic acid and genus Bifidobacteriumin in SCZ patients were correlated with the general psychopathology score, with a regression coefficient of -29.240 (F=8.655, P=0.007). There was no statistical correlation between the aforementioned interaction term and cognitive function (both P>0.05).

In first-episode, drug-free SCZ patients, there were decreases in the serum folic acid level and the relative abundance of genus Bifidobacterium, which were related to the psychiatric symptoms, suggesting that these two substances can be used as potential objective indicators for evaluating psychiatric symptoms.

To investigate the dynamic functional connectivity (dFC) abnormalities of the raphe nucleus in adolescent patients with first-episode depression and its correlation with clinical characteristics and cognitive function.

A total of 30 adolescent patients with untreated depression [Depression Groups, 17 males and 13 females, median age 16.5 (15.0, 17.0) years] and 29 age-, gender-and education-[Healthy Controls, 17 males and 12 females, median age 17.0 (16.0, 18.0) years] matched healthy controls underwent resting functional MRI examinations and their clinical data were obtained in the First Affiliated Hospital of Zhengzhou University.The raphe nuclei was subdivided into dorsal raphe nuclei (DRN) and median raphe nuclei (MRN). Seed-based dFC of the raphe nucleus was conducted to analyze the abnormal dFC between DRN and whole brain gray matter as well as MRN. Clinical characteristics and cognitive function were evaluated using HAMD-17 and Wisconsin card sorting (WSCT), respectively. The difference of dFC between the two groups was compared. The variance values of dFC in the different brain regions were extracted and subsequently used for evaluating the correlation between the scores of HAMD-17 as well as cognitive tests.

Compared with HC, the depression group had an significantly increased variance of dFC in the right superior temporal gyrus (MNI coordinate:33,-12,-12; voxel size 468; t=4.715), extending to the right insula, lentiform nucleus, putamen and Rolandic_Oper_R (aal) (GRF correction, voxel-P<0.005,cluster-P<0.05). Significant negative correlations were observed between the variance in the different brain regions and the total scores andthe factor of retardation scores of HAMD-17 as well the total time, the time of correct thinking, the time of mistake thinking and the number of non-persistent errors of WSCT in depression groups (r=-0.388, -0.365, -0.488, -0.470, -0.412, -0.390, respectively, all P<0.05).

The variability of the dFC between the DRN and the temporal insula regions as well as striatum was increased in adolescent patients with untreated depression and associated with the severity and cognitive abnormality.

To compare the hippocampal volume and local surface morphology changes in patients with mesial temporal lobe (mTLE) using the voxel-based morphometry and spherical harmonic methods respectively.

A total of 66 patients (31 males and 35 females, age range from 17 to 48 (28±8) years) with mTLE and 80 age-and gender-matched controls (38 males and 42 females, age range from 19 to 46 (27±7) years) were retrospectively collected from July 2009 to February 2019 at Jinling hospital.. High resolution structural MRI of the whole brain, three-dimensional T₁-weighted data(3DT1) were acquired from each subject. The changes of hippocampal volume and surface morphology were evaluated between mTLE groups and controls for observing the hippocampal atrophy pattern by using voxel-based morphometry and spherical harmonic shape descriptions point distribution model respectively. Pearson correlation analysis was conducted for observing the relationship between the morphological changes of hippocampus and disease duration.

Compared with the controls, hippocampal volume on the affected side in patients with mTLE was significantly reduced (Z-score:-1.55±0.57 vs 0.38±0.58, P<0.001) and negatively correlated with disease duration (r=-0.297, P=0.016). Furthermore, surface morphology analysis subtly showed that the atrophy of the affected hippocampus in patients with mTLE mainly located in the head, mesial lateral part and posterior tail of the hippocampus. Their displacement values were negatively correlated with disease duration (r=-0.336, P=0.006) and positively associated with the hippocampal grey matter volume (r=0.336, P=0.006).

Voxel-based morphometry analysis reveals a global reduction in hippocampal volume, while the morphological measurement method based on surface shape can describe the local morphological changes of hippocampal atrophy.

This retrospective analysis was conducted on clinical obtained DCE-MR images of 198 patients, age from 21 to 79 years(45.5±13.7). The CBAM-ResNet model was developed to perform the classification automatically at the image-level based on deep learning method using the pathological examination as the reference standard,then the classification result of each individual patient was obtained by ensemble learning. The proposed method can have an accuracy of 82.69% for correctly distinguishing between benign and malignant breast tumors at the slice-level based on CBAM-ResNet model and with a sensitivity of 85.67%.. After the voting mechanism is applied, the classification accuracy can reach up to 88.24% at the patient-level with a sensitivity of 87.50%. Our experimental results demonstrated the proposed approach have a high classification accuracy.

The health industry standard WS/T 662-2020 "Technical Requirements for Clinical Body Fluid Testing" is formulated on the premise of fully inquiring and understanding the body fluid testing guidelines, academic monographs and research papers issued by international standardization institutions, combining the clinical practice experience and laboratory testing status of experts in this field in China, and widely soliciting opinions from colleagues in the industry. The popularization and application of this standard will help to improve the comparability and reliability of the test results of important and commonly used body fluid test items in clinical laboratories, and promote the standardization of body fluid test. This paper will explain the design and key clauses of the standard framework, and help the professional technicians and relevant managers of body fluid examination to better understand and apply the standard.

Drug addiction is a chronic recurrent brain disease with limited treatment and an extremely high recurrence rate. Neuromodulation techniques, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain electrical stimulation (DBS), have good therapeutic prospects in the treatment of drug addiction. Insula lobe is a key brain region in drug addiction, and its value as a neuroregulatory target region in drug addiction needs to be further explored. This paper presents preclinical and clinical evidence on the role of insula in drug addiction, exploring its promise as a brain stimulation target for the treatment of drug addiction.

Talus is the key structure connecting the foot and the lower extremities. It is prone to avascular necrosis after trauma. The goal of the treatment of talus osteonecrosis is to improve the clinical symptoms of patients and preserve the function of ankle joint and hind foot as much as possible. This article aims to review the anatomical and biological characteristics of talus, clinical stages of talar necrosis, conservative treatment of talar necrosis, traditional surgical methods and the latest progress of talar prosthesis.

Long-term chronic ankle instability may lead to osteochondral damage to the parietal talus as well as osteoarthritis. Options for surgery include ligament repair, non-anatomical reconstruction of ligaments, and anatomical reconstruction. Recovery of stability and long-term control of osteoarticular progression are major considerations when choosing surgical techniques. Studies have shown that anatomical reconstruction and anatomical restoration have shown good results in terms of patient satisfaction, ankle stability and mobility. Then, there are few studies on the changes in the cartilage composition of the talar parietal and subtalar joints after anatomical reconstruction and repair. Morphological magnetic resonance imaging (MRI) is one of the most useful tools for identifying degenerative articular cartilage changes based on changes in signal intensity and morphological features. However, the role of morphological MRI sequences in the diagnosis of early cartilage degeneration is limited. The T2/T2*mapping sequence is a well-established technique to evaluate early cartilage degeneration by quantifying cartilage matrix degeneration. Evidence suggests that elevated T2/T2* values may be associated with collagen disorders and increased water content in cartilage, which can be used as a sensitive indicator of early cartilage degeneration. Compared with T2mapping, T2*mapping has the advantages of shorter acquisition time and higher resolution, and has been used to evaluate articular cartilage.

Chronic ankle instability is a common orthopedic problem. In acute ankle sprains, up to 40% of patients may develop chronic ankle instability. In most cases, the modified Broström procedure can repair the anterior talofibular ligament injury and stabilize the ankle joint. However, ligament reconstruction may be a better option for patients with severe ligament laxity, excessive local soft tissue defects, heavy body weight, high exercise requirements, underlying deformities, or previous failure of ligament repair. Non-anatomical ligament reconstruction, including Watson-Jones and Chrisman Snook surgery, may lead to peroneal tendon fatigue, subtalar stiffness and osteoarthritis, calf atrophy, and persistent instability due to changes in the biomechanics of the ankle and subtalar joints, which may affect the long-term efficacy. Therefore, anatomical ligament reconstruction is generally recommended when ligament reconstruction is required. Recent studies have shown satisfactory clinical and imaging results in anatomical reconstruction of the lateral ankle ligament with autologous hamstring muscle transplantation for primary cases of severe chronic ankle instability. However, few studies have evaluated the effectiveness of this surgical approach in revision cases. Furthermore, there are currently no studies comparing the results of primary reconstruction and revision reconstruction of the lateral ligament with hamstring transplantation.