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BACKGROUND: Artificial intelligence (AI) technology is a promising diagnostic adjunct in fracture detection. However, few studies describe the improvement of clinicians’ diagnostic accuracy for nasal bone fractures with the aid of AI technology. OBJECTIVE: This study aims to determine the value of the AI model in improving the diagnostic accuracy for nasal bone fractures compared with manual reading. METHODS: A total of 252 consecutive patients who had undergone facial computed tomography (CT) between January 2020 and January 2021 were enrolled in this study. The presence or absence of a nasal bone fracture was determined by two experienced radiologists. An AI algorithm based on the deep-learning algorithm was engineered, trained and validated to detect fractures on CT images. Twenty readers with various experience were invited to read CT images with or without AI. The accuracy, sensitivity and specificity with the aid of the AI model were calculated by the readers. RESULTS: The deep-learning AI model had 84.78% sensitivity, 86.67% specificity, 0.857 area under the curve (AUC) and a 0.714 Youden index in identifying nasal bone fractures. For all readers, regardless of experience, AI-aided reading had higher sensitivity ([94.00 ± 3.17]% vs [83.52 ± 10.16]%, P< 0.001), specificity ([89.75 ± 6.15]% vs [77.55 ± 11.38]%, P< 0.001) and AUC (0.92 ± 0.04 vs 0.81 ± 0.10, P< 0.001) compared with reading without AI. With the aid of AI, the sensitivity, specificity and AUC were significantly improved in readers with 1–5 years or 6–10 years of experience (all P< 0.05, Table 4). For readers with 11–15 years of experience, no evidence suggested that AI could improve sensitivity and AUC (P= 0.124 and 0.152, respectively). CONCLUSION: The AI model might aid less experienced physicians and radiologists in improving their diagnostic performance for the localisation of nasal bone fractures on CT images.

Intracerebral hemorrhage (ICH) is lethal but lacks effective therapies. Nicotinamide adenine dinucleotide (NAD+) is a central metabolite indispensable for a broader range of fundamental intracellular biological functions. Reduction of NAD+ usually occurs after acute brain insults, and supplementation of NAD+ has been proven neuroprotective. P7C3-A20 is a novel compound featuring its ability to facilitate the flux of NAD+. In this study, we sought to determine the potential therapeutic value of P7C3-A20 in ICH. In collagenase-induced ICH mouse models, we found that P7C3-A20 treatment could diminish lesion volume, reduce blood-brain barrier (BBB) damage, mitigate brain edema, attenuate neural apoptosis, and improve neurological outcomes after ICH. Further, RNA sequencing and subsequent experiments revealed that ICH-induced neuroinflammation and microglial proinflammatory activities were significantly suppressed following P7C3-A20 treatment. Mitochondrial damage is an important trigger of inflammatory response. We examined mitochondrial morphology and function and found that P7C3-A20 could attenuate OxyHb-induced impairment of mitochondrial dynamics and functions in vitro. Mechanistically, Sirt3, an NAD+-dependent deacetylase located in mitochondria, was then found to play a vital role in the protection of P7C3-A20 against mitochondrial damage and inflammatory response. In rescue experiments, P7C3-A20 failed to exert those protective effects in microglia-specific Sirt3 conditional knockout (CKO) mice. Finally, preclinical research revealed a correlation between the plasma NAD+ level and the neurological outcome in ICH patients. These results demonstrate that P7C3-A20 is a promising therapeutic agent for neuroinflammatory injury after ICH and exerts protective actions, at least partly, in a Sirt3-dependent manner.

Objectives To investigate the clinical effect of percutaneous vertebroplasty (percutaneous vertebroplasty, PVP) and percutaneous kyphoplasty (percutaneous kyphoplasty, PKP), PVP) in the treatment of osteoporotic vertebral fracture (osteoporotic vertebral compression fractures, OVCF). Methods From March 2016 to June 2019, we treated the patients who were admitted to our hospital from March 2016 to June 2019. The clinical data of 150 OVCF patients were analyzed retrospectively, and it was divided into PKP group (group A), PVP group (group B) and PVP + traditional Chinese medicine hyperextraction reduction method group (group C) according to different operation methods, and 50 cases in each group. Preoperative, postoperative 1d,3-month,6-month,1-year pain-visual analogue scale (VAS) was used to assess the degree of pain relief of the back and back of the patient, and the range of motion of the thoracolumbar spine was assessed. The recovery of degree, the recovery of kyphosis Cobb angle, the refracture of injured vertebrae and adjacent vertebrae after operation, and the trend of long-term stability of spine were followed up. Results The operation was smooth and there were no complications such as incision infection and deep venous thrombosis. At 3 months and 6 months after operation, there was significant difference between PVP overextended reduction group (group C) and PKP group (group A), PVP group (group B). The recovery rate of Cobb angle in sagittal plane of injured vertebrae was compared before and after operation. 1 day, 3 months, 6 months, 1 year follow-up. There was no significant difference between group C and group A and group B (P 0.05). There was no significant difference in the improvement rate of ODI between group C and group A. there was no significant difference in the improvement rate of ODI between group C and group A. there was no significant difference in the improvement rate of ODI between group C and group A at 1 day, 3 months and 1 year after operation. During the follow-up of 6 months after operation, there was significant difference between group C and group A and group B (P 0.05). There was a significant difference between group C and group A and B at 1 month, 3 months and 6 months after operation (P 0.05). Conclusions The three methods of reduction and fixation (PKP,PVP and PVP) are effective in relieving pain, strengthening vertebral body, stabilizing injured vertebra, restoring vertebral body height and correcting kyphosis of thoracolumbar spine. However, in the course of long-term follow-up, simple PVP The residual low back pain or recurrence in patients with PKP, the loss of the height of injured vertebrae, the occurrence of fractures and even the complications of refracture of adjacent vertebrae after enhanced operation, resulting in the decrease of the balance and long-term stability of spinal muscle and bone system. And then increase the degeneration process of the thoracolumbar segment of the spine.

Self-gravitation traction is 1 of the most popular treatments for lumbar disc herniation (LDH). This study aims to evaluate the effectiveness and safety of the self-gravitation traction device in the treatment of LDH and to confirm its positive treatment effect.This trial is designed as a pragmatic double-center, single-blind, and 3-arm (1:1:1 ratio) randomized controlled trial. The recruited patients with LDH will be randomly allocated to the intervention (traction weight is 40% or 60% of its body weight) or control (traction weight is 20% of its body weight) group. Traction will be completed within 6 consecutive weeks (3 times a week), with 10 minutes of traction for the first 3 weeks, 20 minutes of traction for the next 3 weeks. After the experiment is completed, we will establish an experiment-related database. The software of SPSS, version 21 (SPSS Inc. Chicago, IL) will be used for statistical analysis, and measurement data will be expressed via mean and standard deviation (mean ± SD).Once the trial is completed, we will publish the study in journals in both Chinese and English to promote the dissemination and use of the results. In addition, we also plan to promote the research results at various academic conferences both domestically and internationally.

Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.After surgery, the patient's symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.