BACKGROUND:This study aims to explore the relationship between urinary phytoestrogen mixed metabolites and the risk of osteoarthritis (OA). METHODS:Using data from the National Health and Nutrition Examination Survey (NHANES), a Weighted Quantile Sum (WQS) regression analysis was conducted to determine the dominant metabolites. Additionally, a Bayesian kernel machine regression (BKMR) model was utilized to explore the combined effects of phytoestrogen mixed metabolites on OA. RESULTS:Compared to the lowest quartile group, the highest quartile group of Enterodiol showed a 46% increased risk of OA (OR = 1.46, 95% CI: 1.09-1.96), while the highest quartile group of Enterlactone showed a 30% decreased risk of OA (OR = 0.70, 95% CI: 0.52-0.96). The WQS regression model analysis revealed a positive relationship between urinary phytoestrogen mixed metabolites and OA risk, with Enterodiol found to have the highest weight in this association. The BKMR model indicated that the association between urinary phytoestrogens and OA increased with concentration but did not reach statistical significance. The univariate exposure-response function demonstrated a positive association between Enterodiol and OA. CONCLUSIONS:There is a positive relationship between urinary phytoestrogen mixed metabolites and OA, with Enterodiol being an important factor influencing OA risk.

Background Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses. Methods In this study, we acquired 1,453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved rigorous preprocessing of images, including normalization and resampling, followed by a comparative evaluation of the models using accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models' predictive focus points. Results The 3D-EfficientNetB7 model demonstrated superior performance, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. Furthermore, Grad-CAM visualizations aligned closely with expert radiologists' assessments, validating the model's diagnostic precision. Spatial localization techniques further enhanced the interpretability of fracture detection, providing clear visual cues for medical professionals. Conclusions The implementation of 3D-CNNs, particularly the 3D-EfficientNetB7 model, significantly improved the detection and localization of ankle fractures. The use of Grad-CAM has also proved essential in providing transparency to AI-driven diagnostics. Our research supports the integration of 3D-CNNs in clinical settings, potentially revolutionizing the standard of care in fracture diagnosis and paving the way for their application in broader medical imaging tasks.

AIM:This study aimed to evaluate the hypothesis that the utilization of percutaneous screw guides enhances the precision of screw placement in the surgical fixation of talar fractures. METHODS:Computed tomography (CT) scans of ankle joints were obtained from 40 healthy adults and 10 cadaveric specimens between April 2019 and August 2020 at Ningbo No. 6 Hospital. The acquired CT data were imported into Materialise Interactive Medical Image Control System (MIMICS) software for processing. Three-dimensional (3D) digital models of the ankle joints were reconstructed, and relevant anatomical parameters were measured. A percutaneous screw guide (PSG) was designed and fabricated to facilitate accurate screw placement in the posterior talar process. Ten eligible cadaveric ankle joints were selected for further analysis and their 3D models were reconstructed using the MIMICS software. Screw trajectory parameters were then measured and analyzed based on these cadaveric models, forming the model group for comparative analyses. Ten cadaveric specimens were utilized in this study, equally divided into two groups: a guider group (n = 5) and a free-hand group (n = 5). In the guider group, talar posterior process screws were inserted using percutaneous screw guidance. In the free-hand group, screws were inserted into the talar posterior process without guidance. Post-operative CT scans were performed on all specimens. The following parameters were quantitatively compared between the two groups: screw trajectories, entry point distances in specimens with preselected screws, entry point distance trajectories in the 3D model, operation time, frequency of fluoroscopic imaging, and number of drilling attempts. RESULTS:Following the generation of the 3D models from 10 cadavers, a virtual screw was digitally inserted into each model. In the model group, the preselected screw trajectory was oriented towards the medial aspect of the talar neck base, with a cephalad inclination angle (CIA) of 3.1° ± 1.5° in the transverse~plane and a medial diverge angle (MDA) of 12.0° ± 1.4° in the coronal plane. The CIA and MDA of the screw trajectory in the guider group were 2.1° ± 1.7° and 11.2° ± 1.6°, respectively, whereas the CIA and MDA in the free-hand group were 6.0° ± 2.2° and 18.8° ± 1.6°, respectively. Statistical analysis revealed significant differences in both CIA and MDA between the two groups (p < 0.05). Furthermore, the guider group yielded superior outcomes in terms of entry point distance, operation time, fluoroscopic exposure time, and number of drilling attempts compared to the free-hand group (p < 0.05). CONCLUSIONS:Percutaneous screw guidance can improve the accuracy and safety of the posterior process of the talar screws, which can be feasible for percutaneous fixation. Further studies are required to confirm the efficacy and clinical outcomes of percutaneous screw guidance.

Background Ankle fractures are prevalent injuries that necessitate precise diagnostic tools. Traditional diagnostic methods have limitations that can be addressed using machine learning techniques, with the potential to improve accuracy and expedite diagnoses. Methods We trained various deep learning architectures, notably the Adapted ResNet50 with SENet capabilities, to identify ankle fractures using a curated dataset of radiographic images. Model performance was evaluated using common metrics like accuracy, precision, and recall. Additionally, Grad-CAM visualizations were employed to interpret model decisions. Results The Adapted ResNet50 with SENet capabilities consistently outperformed other models, achieving an accuracy of 93%, AUC of 95%, and recall of 92%. Grad-CAM visualizations provided insights into areas of the radiographs that the model deemed significant in its decisions. Conclusions The Adapted ResNet50 model enhanced with SENet capabilities demonstrated superior performance in detecting ankle fractures, offering a promising tool to complement traditional diagnostic methods. However, continuous refinement and expert validation are essential to ensure optimal application in clinical settings.

OBJECTIVE:To investigate the clinical effect of orthopedic robot combined with Starr pelvic reduction frame in the treatment of Tile type C pelvic ring fracture.METHODS:From October 2019 to May 2021, 14 patients with type C pelvic ring fracture were treated with robotic combined with Starr pelvic reduction frame, including 9 males and 5 females. The age ranged from 33 to 69 years. All the 14 patients had fresh closed fractures without femur, tibia and fibula fracture. Surgery was completed from 4 to 7 d after hospital admission. During the operation, the X-ray carbon bed was used, the pelvic ring was reduced by Starr pelvis reduction frame, and pelvic ring fracture was treated by orthopedic robot. Operation time, bleeding volume, fluoroscopy times of single screw placement, fracture reduction quality, affected limb function and complications were observed. Radiological reduction was evaluated using Matta scoring standard, and clinical efficacy was evaluated by Majeed pelvic function scoring system at the final follow-up.RESULTS:All of 14 patients successfully completed the operation, the operation time was 84 to 141 min, the bleeding volume was 20 to 50 ml, and the fluoroscopy times of single screw insertion was 4 to 9 times. All of 14 patients were followed up for 12 to 24 months. The healing time was 3 to 7 months. No complications such as fracture of internal fixation, screw loosening, infection and nerve injury were found. According to the evaluation criteria of Matta imaging reduction, 9 cases were excellent, 4 cases were good, and 1 case was fair. At the final follow-up, Majeed pelvic function scoring system was used:10 cases were excellent, 4 cases were good.CONCLUSION:The treatment of type C pelvic ring fracture with robotic combined Starr pelvis reduction frame is simple, time-saving, less trauma, less complications and effective.

Background Posterior malleolus fractures are known to be associated with ankle instability. The complexities involved in obtaining precise laboratory-based spatial pressure measurements of the ankle highlight the significance of exploring the biomechanical implications of these fractures. Methods Finite element analysis was utilized to examine the stress distribution across the contact surface of the ankle joint, both in its natural state and under varied sagittal fracture line angles. The study aimed to identify stress concentration zones and understand the influence of sagittal angles on stress distribution. Results Three distinct stress concentration zones were identified on the ankle's contact surface: the anterolateral tibia, the anteromedial tibia, and the fracture line. The most significant stress was observed at the fracture line when a fracture occurs. Stress at the fracture line notably spikes as the sagittal angle decreases, which can potentially compromise ankle stability. Larger sagittal angles exhibited only minor stress variations at the contact surface's three vertices. It was inferred that sagittal angles below 60° might pose risks to ankle stability. Conclusions The research underscores the potential implications of fractures on the stress profile of the ankle joint, emphasizing the role of the contact surface in ensuring stability. The identification of three zones of stress concentration and the influence of sagittal angles on stress distribution offers a valuable reference for therapeutic decision-making. Further, the study reinforces the importance of evaluating sagittal fracture angles, suggesting that angles below 60° may compromise ankle stability.

Time series have yielded impressive results in numerical prediction, yet the presence of noise can significantly affect accuracy. Although interval prediction can minimize noise interference, most methods only predict upper and lower limits separately, resulting in uninterpretable predictions. In this paper, we propose a novel modeling approach for time-series interval prediction that integrates granular computing and fuzzy cognitive maps (FCMs). Granular computing transforms traditional numerical time series into interval time series. Rather than predicting interval values independently, our method mines the fuzzy relationship between information granules to obtain the affiliation matrix. During the prediction stage, an FCM-based model is established to predict the affiliation matrix. We conducted experiments on six publicly available datasets, and results demonstrate that our method reduces the impact of noise while offering improved interpretability for prediction outcomes. More importantly, our approach yields significantly lower interval prediction errors when compared to other advanced methods.

目的 观察经腋窝入路微型钢板螺钉内固定治疗Ideberg Ⅰ、Ⅱ型肩胛骨骨折的临床疗效.方法 回顾性分析自2020-03-2021-06经腋窝入路内固定治疗的9例Ideberg Ⅰ～Ⅱ型肩胛骨骨折,于腋窝中心作纵形切口长8～10 cm,逐层切开后在背阔肌肌腱的前方进一步显露,手指触摸肱骨头,在肱骨头表面可触及腋神经,使用深拉钩顿性分离并用橡皮筋保护,切开关节囊直视下复位骨折端,5例采用2枚直径3.0 mm空心钉固定,2例采用单纯微型锁定钢板固定,2例采用微型锁定钢板联合空心钉内固定.结果 9例均获得随访,随访时间6～22个月,平均14个月.所有患者均获得骨性愈合,骨折愈合时间为(11.0±1.5)周.末次随访时肩关节功能Hardegger评分:优5例,良3例,差1例.功能评分为差的1例术后出现腋神经损伤症状,术后10个月症状缓解,残留三角肌萎缩,肌力4级.1例用骨膜剥离子顿性分离时损伤肩胛下动脉,术中予以结扎.结论 经腋窝入路微型钢板螺钉内固定治疗Ideberg Ⅰ、Ⅱ型肩胛骨骨折可取得较为满意的临床疗效,与Judet入路及后方外侧微创直切口相比具有出血量少、恢复快、切口隐蔽等优点.

OBJECTIVETo explore clinical efficacy of staged surgery in treating complex closed Pilon fracture.METHODSFrom June 2019 to January 2021, 29 patients with complex closed Pilon fracture were treated by staging surgery, including 18 males and 11 females, aged ranged from 31 to 68 years old with an average of (43.50±6.62) years old;7 cases were typeⅡand 22 cases were type Ⅲ according to Ruedi-Allgower classification. All patients had fresh closed fractures without talus and calcaneal fractures. The time from injury to closed reduction and external fixation, the interval between two stages of surgery, fracture healing time and complications were recorded. American Orthopedic Foot and Ankle Society(AOFAS) was used to assess clinical effects. Burwell-Charnley system was used to evaluate radiological reduction.RESULTSAll 29 patients were followed up from 13 to 30 months with an aver age of (15.43±5.31) months. All fractures healed well from 2 to 6 months with an average of (3.77±1.22) months. No internal fixation fracture, screw loosening, infection, internal fixation irritation, ankle stiffness occurred. The time from injury to closed reduction and cross-ankle fixation ranged from 1.22 to 7.34 h with an average of(2.31±3.52) h, the interval between two stages ranged from 5 to 9 days with an average of (5.98±2.11) days. AOFAS score was improved from 34.11±6.89 before operation to 90.10±10.11 after oepration at 12 months(P<0.05). According to AOFAS grading, 16 patients got excellent result, 9 good and 4 moderate. Fifteen patients got anatomic reduction, 12 patients were good reduction, and 2 cases were poor reduction according to Burwell-Charnley system.CONCLUSIONStaged surgery for complex closed Pilon fracture has advantages of less complications, statisfied reduction, stable fixation, which could obtain good recovery of ankle joint.

Objective:To investigate the efficacy of treatment of Sanders Ⅱ & Ⅲ calcaneal fractures with an absorbable stick plus Kirschner wire through the tarsal sinus incision.Methods:From July 2017 to May 2020, 37 patients with 42 Sanders Ⅱ & Ⅲ calcaneal fractures were treated with an absorbable stick plus Kirschner wire through the tarsal sinus incision at The Third Ward of Department of Traumatic Orthopeadics, The Sixth Hospital of Ningbo. There were 25 males and 12 females, with an age of (48.2±5.6) years (from 20 to 69 years). The fractures were at the left side in 12 cases, at the right side in 20 and at bilateral sides in 5. By Sanders classification, 20 fractures were type Ⅱ and 22 ones type Ⅲ. Fracture union time and complications were recorded. Their B?hler and Gissane angles were compared between preoperation, postoperation and the last follow-up. The range of motion of the subtalar joint was evaluated by the Morrey method at 6 months postoperation. The functional recovery was evaluated by the American Society of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at 12 months postoperation.Results:The 37 patients were followed up for (15.2±2.7) months (from 13 to 18 months). There were no such complications as incision skin necrosis, Kirschner wire deformation, loss of fracture reduction or Kirschner wire infection. The anatomical morphology of the calcaneus was restored satisfactorily in the 37 patients. At preoperation, postoperation and the last follow-up, the B?hler angles were 13.3°±1.6°, 32.5°±5.5° and 32.7°±5.4° and the Gissane angles 78.3°±6.7°, 127.2°±6.7° and 128.0°±6.4°, respectively, showing significant differences between the preoperative and postoperative values ( P<0.05) but no significant differences between postoperation and the last follow-up ( P>0.05). The range of motion of the subtalar joint at 6 months postoperation was slightly limited in 25 cases and moderately limited in 12 cases, giving a rate of moderate and above limitation of 32.4% (12/37). By the AOFAS ankle-hindfoot score at 12 months postoperation, 12 cases were excellent, 21 ones good and 4 ones fair, giving a good to excellent rate of 89.2% (33/37). Conclusion:Treatment with an absorbable stick plus Kirschner wire through the tarsal sinus incision may lead to fine clinical efficacy for Sanders Ⅱ & Ⅲ calcaneal fractures.

Recently, fuzzy cognitive maps (FCMs) have been applied to the problem of time series classification and have achieved superior performance. However, the existing methods either have difficulty handling large scales or are sensitive to time series containing noise. In addition, the decision-making process of the existing methods is not transparent. In this article, a two-stage FCMs approach is proposed. The proposed method is fundamentally different from traditional methods. After obtaining the time series feature components, instead of directly training the classification model, FCMs are used to learn the causal relationship of the feature components. Because the causal weight of the feature is unique, it has a high degree of recognition and can improve accuracy. In the feature extraction stage, singular spectrum analysis is employed to separate noise and extract meaningful information from time series. The time series is transformed into a multivariate time series. Then, FCMs are used to model the time series, which can extract features quickly and efficiently. Finally, the FCMs feature matrix of the time series is obtained. In the classification stage, we build a classification model based on FCMs to classify the feature matrix. This approach is termed two-stage FCMs. A series of experiments involving public data and bearing data containing noise are believed to prove that the proposed method can more effectively extract features from noisy data. Compared with state-of-the-art methods, the two-stage FCMs method performs well and, more importantly, is transparent and interpretable.

In recent years, classification based on fuzzy cognitive maps (FCM) has received extensive attention, has been applied in many engineering problems, and has proven to work well. However, a host of the existing methods are designed for specific engineering problems, which lack universality and low classification accuracy. In this study, a straightforward and versatile model is proposed to deal with classification. The key of the model is to integrate the capsule network into the inference rules. It forms a new inference rule with a strong coupling coefficient. Weights were learned with a particle swarm algorithm, and the cross-entropy with constraints was used as the cost function. The goal of this research is to maintain the interpretability of the model and enhance its universality and classification performance. The top-down feedback mechanism of the capsule network can meet this requirement. A series of experiments involving public data proved that the proposed method achieves better performance than the previous results obtained using low-level cognitive maps. The comparative analysis also demonstrates the performance of the classification delivered by the proposed model.

Objective Surgical treatment for Schatzker type II tibial plateau fractures remains challenging and requires high‐quality research. The aim of the study is to compare the “windowing” and “open book” techniques for the treatment of Schatzker type II tibial plateau fractures. Methods In this prospective study, all patients with Schatzker type II tibial plateau fractures between January 2014 and December 2017 were managed by open reduction and internal fixation using an anterolateral incision approach. “Windowing” group included 78 patients (53 men and 25 women), with an average age of 57.7 ± 13.5 years, who underwent the “windowing” technique, in which the procedure was performed through a small cortical window against the depressed zone of the lateral plateau. The “open book” group included 80 patients (56 men and 24 women), with an average age of 54.8 ± 12.4 years, who underwent the technique. The clinical outcomes included the Rasmussen classification of knee function and grading of post‐traumatic arthritis. The radiographic outcome (x‐ray and computed tomography [CT]) was the reduction quality of the lateral plateau based on the modified Rasmussen radiological assessment. The patient‐reported outcome was visual analogue scale (VAS) scores. Results The mean follow‐up time for the158 patients was 32 months (range, 24–42 months). The time elapsed from injury to surgery in “windowing” group and “open book” group were 3.7 ± 1.2 (range, 1–10 days) and 3.5 ± 1.4 days (range, 1–11 days), respectively, with no significant difference between the groups (P > 0.05). The operation times did not differ significantly between the “windowing” group (61.0 ± 8.3 min, range, 45–120 min) and the “open book” group (61.2 ± 10.4 min, range, 40–123 min) (P > 0.05). After surgery, CT revealed five (6.4%) and 15 (18.8%) cases of articular depression in the “windowing” and “open book” groups, respectively. Significant differences were observed in the articular depression of tibial plateau fractures between the groups (P < 0.05). However, condylar widening or valgus/varus did not differ significantly between the groups. Furthermore, no significant differences in knee function were observed during follow‐up (P > 0.05). VAS scores were similar between the groups at 24 months after surgery (P > 0.05). There were significant differences in the number of severe post‐traumatic arthritis (grades 2 and 3) cases between the groups (P < 0.05). Conclusions The “windowing” and “open book” techniques are both effective for the treatment of Schatzker type II tibial plateau fractures. However, the “windowing” technique provides better reduction quality, leading to a satisfactory prognosis.

Objective Valgus‐impacted femoral neck fractures with or without posterior tilt of the femoral head are very common and full of pitfalls in clinical practice, which may lead to femoral neck shortening (FNS) and avascular necrosis (AVN). The study tries to introduce a novel technical trick aiming at anatomical reduction of valgus‐impacted femoral neck fracture with minimally invasive procedure, and summarize the clinical prognosis in case series. Methods In this retrospective study, 24 patients (seven men and 17 women) with valgus‐impacted femoral neck fractures between May 2017 and July 2020 were managed by “in‐out‐in” percutaneous reduction technique (percutaneous reduction group). Another 24 cases (10 men and 14 women) suffering the fractures underwent in situ fixation were enrolled as control group for function comparison (in situ fixation group). All patients were followed up for 24–42 months. The clinical outcomes included complications after operations (χ2 test) and Harris Hip Score (HHS) for hip function (unpaired t test) in the two groups. The radiographic outcomes were evaluated by collodiaphyseal angle, posterior tilt angle, and FNS before the operation and during the follow‐up in the percutaneous reduction group (unpaired t test). Results Patients' preoperative data, including age, sex, affected side, fracture types, and medical history, were similar between the two groups, respectively (p > 0.05). After surgery, the mean HHS at 6, 12, and 24 months were all better in the percutaneous reduction group (76 ± 6.72, 85.34 ± 6.33 and 90.54 ± 5.81) than that in the in situ fixation group (70.86 ± 6.91, 80 ± 6.11 and 84.1 ± 7.82), respectively (p < 0.05). One patient suffered fixation failure with screws retreat and one patient suffered AVN in the percutaneous reduction group. In the in situ fixation group, AVN occurred in two patients at last follow‐up. There was no significant difference in complication amounts between the two groups (p > 0.05). In the percutaneous reduction group, collodiaphyseal angle, posterior tilt angle, and amount of FNS were significantly different between preoperative cases and immediately postoperative cases (p < 0.05). However, there was no statistical difference of the measurements among postoperative cases at different time points (within 24 h, 6 months, and 2 years postoperatively) (p > 0.05). Conclusions Our experience of the technique and the case series show that “in‐out‐in” percutaneous reduction technique for treatment of valgus‐impacted femoral neck fracture with or without posterior tilt of the femoral head is safe and effective for achieving successful bone union and satisfactory function.

为有效、快速地处理含噪声数据,提出将轴承故障诊断建模为时间序列分类任务.利用奇异谱分析将一维时间序列扩展为多维时间序列,并实现降噪;利用凸优化算法快速、有效地从噪声数据中学习到FCMs模型,将时间序列转换成C×C的特征矩阵;采用神经网络对特征矩阵进行分类.利用CWRU轴承数据集对所提出的方法进行验证,结果表明:与传统方法相比,所提方法在轴承故障诊断方面的性能较优.

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

Background. Osteoporotic thoracolumbar compression fractures have become a great social burden due to the aging tendency of population. This study is aimed at comparing the clinical and radiological outcomes of percutaneous kyphoplasty with or without pedicle screw fixation in patients with osteoporotic thoracolumbar fractures. Hypothesis. There is a difference in clinical outcomes between percutaneous kyphoplasty with pedicle screw fixation and percutaneous kyphoplasty. Methods. This retrospective study included 87 patients who received percutaneous kyphoplasty with or without pedicle screw fixation between October 2015 and October 2017 at Ningbo No.6 Hospital and were followed for 2 years. A total of 40 patients received percutaneous kyphoplasty with pedicle screw fixation (PKPF group), and the other 47 patients had percutaneous kyphoplasty only (PKP group). The outcomes were measured using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Cobb angle (CA), and anterior vertebra height rate (AVHr), which were calculated at preoperative admission and each follow-up visit. Complications including postoperative back pain, refracture, and fixation failure were collected from medical records. Results. There was no significant difference in baseline characteristics or preoperative data between the two groups ( p < 0.05 ) but significantly better improvements in VAS, ODI, CA, and AVHr at 12- and 24-month follow-up visits in the PKPF group compared with those of the PKP group. 23 (48.9%) patients in the PKP group had complications, whereas only 5 (12.5%) patients in the PKPF group presented complications including 2 postoperative back pain and 1 fixation failure ( p = 0.04 ). Conclusions. PKPF obtained longer correction and better improvement in VAS, ODI, and CA in patients with osteoporotic thoracolumbar vertebral fractures than PKP.

BACKGROUND:The real time series is affected by various combinations of influences, consequently, it has a variety of variation modality. It is hard to reflect the variation characteristic of the time series accurately when simulating time series only by a single model. Most of the existing methods focused on numerical prediction of time series. Also, the forecast uncertainty of time series is resolved by the interval prediction. However, few researches focus on making the model interpretable and easily comprehended by humans.METHODS:To overcome this limitation, a new prediction modelling methodology based on fuzzy cognitive maps is proposed. The bootstrap method is adopted to select multiple sub-sequences at first. As a result, the variation modality are contained in these sub-sequences. Then, the fuzzy cognitive maps are constructed in terms of these sub-sequences, respectively. Furthermore, these fuzzy cognitive maps models are merged by means of granular computing. The established model not only performs well in numerical and interval predictions but also has better interpretability.RESULTS:Experimental studies involving both synthetic and real-life datasets demonstrate the usefulness and satisfactory efficiency of the proposed approach.

Purpose: The purpose of this study was to clinically compare the single-incision and dual-incision approaches for the treatment of distal tibial and fibular fractures. Methods: In total, 93 patients were enrolled, and the mean follow-up was 15 months (range 12–19 months). The patients treated for open reduction and internal fixation were randomly classified into two groups based on the approach used: 45 patients were treated using the single-incision approach (group 1) and 48 patients were treated using the dual-incision approach (group 2). In these two groups, operation time, discharge time, postoperative complications, and ankle function evaluations (Olerud–Molander Ankle Score) were compared between the two groups. Results: There were no significant differences in the mean operation time (98.2 ± 18.5 vs. 103.6 ± 19.3), discharge time (11.1 ± 3.9 vs. 12.5 ± 5.7), overall surgical complication rates (9/45 vs. 15/48), or ankle function between the two groups ( p > 0.05). However, the rate of soft tissue-related complications, such as skin slough, infection, nonunion, and delayed union, was significantly lower in group 1 (5/45) than in group 2 (14/48) ( p < 0.05). Conclusion: The two incision approaches were found to have similar clinical outcomes. However, with regard to soft tissue conservation, the single-incision approach was superior to the dual-incision and maybe a reliable alternative.

Purpose: To determine the levels of matrix metalloproteinases (MMPs) in response to orthodontic tooth movement, in order to clarify the relationship between the change of MMPs and distance of tooth retraction. Materials and methods: In total, 11 patients who needed tooth extraction and 11 patients who didn't before being subjected to fixed orthodontic appliance therapy were assigned into two groups: The extraction group and the nonextraction group. The saliva samples were collected from each patient at four indicated time points, including the first visit time (T1), time before fitting the orthodontic appliance (T2), one hour after (T3) and eight weeks after fitting the appliance (T4). Salivary MMPs concentration was determined using multiplexed bead immunoassay. Alginate impressions were taken at T1 and T4. Results: In the non-extraction group, the concentration of MMP-8 and MMP-9 were significantly increased at T3. In the extraction group, the concentration of MMP-8, MMP-9, and MMP-12 increased during the orthodontic tooth movement process, reaching a peak at T3. In particular, orthodontic tooth movement was positively associated with MMP-8, MMP-9, and MMP-12 levels in saliva at T3 in the extraction group. Conclusions: The result of our present study suggested that orthodontic force could modulate MMPs levels in saliva. MMP-8, MMP-9 and MMP-12 in saliva may represent novel indicators of the degree of orthodontic tooth movement.