BACKGROUND:At present,open reduction and internal fixation and minimally invasive needle aspiration are commonly used in patients with Sanders types Ⅱ and Ⅲ calcaneal fractures.However,there is little comparison between the clinical efficacy of the two methods and high-level clinical evidence is still available. OBJECTIVE:To compare the curative effect of Sanders types Ⅱ and Ⅲ calcaneal fractures treated by three-dimensional digital model-assisted minimally invasive needle penetration and tarsal sinus incision and manual reduction and internal fixation with steel plate. METHODS:From January 2021 to October 2022,80 patients with Sanders types Ⅱ and Ⅲ calcaneal fractures who were treated in the Department of Orthopedics,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were randomly divided into control group(40 cases)and observation group(40 cases).The control group was treated with manual reduction and internal fixation with steel plate through the traditional tarsal sinus incision,while the observation group was treated with a three-dimensional digital model assisted with minimally invasive needle penetration fixation.The operation time,blood loss,hospitalization time and fracture healing time of the two groups were recorded.The changes in Maryland score,AO-FAS score,pain visual analog scale score,quality of life score(SF-36 score),and imaging parameters(B?hler angle,Gissane angle,calcaneal length,width and height)were observed before and 12 months after operation in the two groups.The complications during the follow-up were recorded. RESULTS AND CONCLUSION:(1)Operation time,blood loss,hospitalization time and fracture healing time in the observation group were lower than those in the control group(all P<0.05).(2)The Maryland score,AO-FAS score,SF-36 score,B?hler angle,Gissane angle,calcaneal length and height of the two groups after treatment were significantly higher than those before treatment(all P<0.05).Visual analog scale score and calcaneal width were significantly lower than those before treatment(all P<0.05).(3)After 12 months of follow-up,the incidence of complications in the observation group was lower than that in the control group(all P<0.05).(4)In conclusion,the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures with three-dimensional digital model-assisted minimally invasive needle penetration fixation can significantly improve the operation time,bleeding volume and other perioperative indicators,and can reduce the occurrence of multiple complications.The recovery of ankle function,relief of pain symptoms,and improvement of quality of life are equivalent to traditional therapy.

Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.

Clinical data of a teenager with slipped capital femoral epiphysis (SCFE) combined with primary hyperparathyroidism (PHPT) treated in the Children′s Hospital of Soochow University in May 2022 were retrospectively analyzed.A girl, aged 13 years and 5 months, had claudication of both lower limbs for 1.5 years, and the symptom was aggravated for 1 month.X-ray examination of the hip joint showed bilateral SCFE.However, the patient had a body mass index of 18.2 kg/m 2 and no trauma, which did not meet the typical characteristics of SCFE.Further ultrasound examination of the parathyroid gland shows parathyroid adenoma.And parathyroid adenoma was considered to cause PHPT, which in turn triggered SCFE.After surgical resection of the PHPT, the patient had a better fusion of the femoral head and femoral neck and improved hip joint function.Therefore, SCFE fixation was not performed.The diagnosis and treatment of this patient indicated that for similar patients with SCFE and PHPT, SCFE may not be treated with internal fixation, if the femoral head and femoral neck have been fused, the hip joint function has improved, and the pain has been relieved after resection of PHPT.In patients with SCFE and PHPT, the management of hyperparathyroidism takes precedence over the treatment of SCFE.Acute and acute-on-chronic slip, with or without PHPT-induced hypercalcemia, should be treated first by SCFE fixation, and excising parathyroid adenoma should be performed simultaneously or as soon as possible.For chronic slip patients who have mild to moderate hypercalcemia and one or more related symptoms, parathyroidectomy should be performed firstly, and then the SCFE fixation should be considered after parathyroid hormone and blood calcium levels become stable.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression(PSD).Methods The clinical data of 179 patients with ischemic stroke were included,and the demographic information,medical history,stroke severity and laboratory indicators at admission were collected.After 6 months of follow-up,all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale(HAMD-17).Patients were divided into the PSD group(48 cases)and the non-PSD group(131 cases).Differences in clinical characteristics were compared between the PSD group and the non-PSD group.CALLY index was calculated from C-reactive protein(CRP),albumin(ALB)and lymphocyte counts.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CALLY index to PSD.Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients.K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD.Results The CALLY index of 179 patients ranged from 0.54 to 1.79,with a median of 1.08.ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09,and the area under ROC curve was 0.757(95%CI:0.687-0.818).Compared with the non-PSD group,the proportion of females was higher in the PSD group,and the proportion of patients with hyperlipidemia was increased with shorter years of education.The serum C-reactive protein(CRP)was higher,and albumin(ALB)and CALLY index were lower(P＜0.05).The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group(CALLY≤1.08)than that in the higher CALLY index group(CALLY＞1.08,33.0%vs.20.5%,Log rank χ2=8.553,P=0.004).Cox regression analysis showed that after adjusting for other covariates,the decreased CALLY index was an independent risk factor for PSD(HR=2.651,95%CI:1.269-5.540,P＜0.05).Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients,which is helpful for early identification and timely intervention to improve the prognosis of patients.

Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.

Cognitive impairment is a common dysfunction after central nervous system disease or injury, which seriously affects the daily life of patients and brings heavy economic burdens to the family and society. Neurofeedback training (NFT) based on electroencephalography (EEG) is a non-invasive method of neuroregulation, which can improve cognitive function and behavior by autonomously adjusting brain function through feedback. This paper reviews the application of EEG signal-based neurofeedback training in cognitive rehabilitation, and discusses the current problems and future development trends in this field, so as to provide new ideas for clinical research and treatment of cognitive disorders.

Objective To compare the preparation efficiency of mouse pox and mouse hepatitis antibodies between two substrains of BALB/c and Big-BALB/c (B-BALB/c) mice, and to provide a theoretical basis and reference for the selection of laboratory animals in the preparation of monoclonal antibodies inducedin vivo through hybridoma.Methods Individuals weighing more than 5% of the weight of normal animals at 4 weeks of age (the criterion for late selection is more than 10%) were selected from a population of conventionally bred BALB/c mice and bred individually, and a subline of B-BALB/c mice was prepared after 10 generations of selection. A total of 40 BALB/c mice and 40 B-BALB/c mice aged 10 to 11 weeks, half male and half female, were selected and inoculated with the mousepox monoclonal antibody hybridoma cell line G23 or the murine hepatitis monoclonal antibody hybridoma cell line Y15 pre-treated with liquid paraffin, respectively. Mice ascites containing monoclonal antibodies were obtained by in vivo induction. The antibody titer was tested by indirect ELISA. The mice were grouped based on the sub-strains, gender and inoculation type of hybridoma to analyze the ascites production, antibody titer and antibody production, and to evaluate the antibody preparation efficiency of the two BALB/c mouse sub-strains.ResultsAfter 10 generations of breeding, the body weight of 10-week-old male and female B-BALB/c mice increased by 22.3% and 12.8%, respectively, compared with BALB/c mice of the same age. Compared with BALB/c mice, B-BALB/c mice had better tolerance and adaptation to secondary ascites collection. Compared with BALB/c mice, the ascites production and antibody titer during the preparation of antibodies in B-BALB/c mice were significantly increased, especially in the hybridoma cell line G23 vaccination group (both P＜0.000 1) . After inoculation with the hybridoma cell lines G23 or Y15, the average antibody production of B-BALB/c mice (14.99×10⁴ U and 33.22×10⁴ U) was higher than that of BALB/c mice (5.33×10⁴ U and 19.31×10⁴ U) (both P＜0.01). After inoculation with hybridoma cell line G23, the average antibody production per unit body weight of B-BALB/c mice (0.55×10⁴ U/g) was higher than that of BALB/c mice (0.23×10⁴ U/g) (P＜0.000 1). And the antibody production per unit body weight of female B-BALB/c or BALB/c mice was higher than that of male B-BALB/c or BALB/c mice (bothP＜0.01).Conclusion B-BALB/c mice can be used as an alternative to BALB/c mice in the in vivo induction of monoclonal antibody preparation, which can achieve the purpose of reducing the number of experimental animals used, lowering the labor cost, and improving the efficiency of antibody preparation.

Objective To investigate the efficacy and safety of lenvatinib in patients with unresectable hepatocellular carcinoma (HCC) previously treated with tyrosine kinase inhibitor (TKI). Methods A retrospective analysis was performed for the clinical data of 76 patients with unresectable HCC who were treated with lenvatinib in Beijing Ditan Hospital, Capital Medical University, from January 2019 to January 2020, and according to the treatment method, they were divided into TKI previously untreated group with 49 patients and TKI treatment-experienced group with 27 patients. The patients were observed till one year after enrollment, adjustment of treatment regimen, tumor progression, or death. The two groups were compared in terms of progression-free survival (PFS) time, objective response rate (ORR), disease control rate (DCR), and incidence rate of adverse events. The t -test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups, and the chi-square test or the Wilcoxon rank-sum test was used for comparison of categorical data between two groups; the Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison between groups. Results There were no significant differences between the TKI previously untreated group and the TKI treatment-experienced group in median PFS time (115 days vs 72 days, P =0.148), ORR (36.7% vs 18.5%, P =0.098), DCR (65.3% vs 55.6%, P =0.402), and incidence rates of grade ≥3 adverse events (24.5% vs 18.5%, P =0.550). Conclusion Patients with unresectable HCC previously treated with TKI can benefit from lenvatinib and have good safety, with similar results to those treated with TKI for the first time.

Objective:To investigate and analyze the distribution of pathogens and to explore the related risk factors of infections in burn patients in order to provide theoretical basis for effective prevention and treatment of wound infections in burn patients.Methods:A total of 245 burn patients, admitted to the PLA 926 Hospital from January 2016 to December 2020, were selected. The pathogens and antimicrobial susceptibility of the wound secretions were tested and the clinical data of burn patients were collected. The risk factors of burn wound infection were screened by single factor comparison method and multivariate logistic regression.Results:Among the 245 burn patients, 184 patients were with bacterial infections, the infection rate was 75.10% (184/245), and 79 patients were multi-drug resistant, accounting for 42.93%(79/184). A total of 367 strains of pathogens were isolated from wound secretions in the 184 patients, among which 72 (19.62%, 72/367) strains were gram-positive bacteria, mainly Staphylococcus aureus (11.44%, 42/367), 283 (77.11%, 283/367) strains were gram-negative bacteria, mainly Pseudomonas aeruginosa (20.16%, 74/367) and Acinetobacter baumannii (19.89%, 73/367), and 12 (3.27%, 12/367) strains were fungi, mainly Aspergillus (1.91%, 7/367). The results of drug sensitivity tests showed that the pathogens of burn patients were highly resistant to common antibiotics. Monofactor analysis showed that age(χ 2=8.629, P=0.013), burn area (χ 2=21.504, P=0.002), wound depth (χ 2=17.139, P=0.000), hypovolemic shock (χ 2=21.112, P=0.000) and length of hospital stay (χ 2=21.967, P=0.000) were the related risk factors for wound infections. Multivariate logistic regression analysis showed that ages below 4 years old or over 69 years old ( OR=8.414,95% CI:2.971-23.830, P=0.000), burn area>30% ( OR=5.672,95% CI:1.029-31.272, P=0.046), Ⅲ degree wound ( OR=4.069,95% CI:1.396-11.858, P=0.010), length of hospital stay≥15 days ( OR=2.593,95% CI:1.091-6.162, P=0.031) were the independent risk factors of wound infections in burn patients. Conclusions:The incidence of wound infection and multi-drug resistance is relatively high in burn patients, and the pathogens are mainly gram-negative bacteria. Age, burn area, burn wound depth and length of hospital stay are the high-risk factors for wound infections, and taking effective preventive measures according to risk factors can reduce the occurrence of wound infections and hospital infections.