Objective To evaluate the biomechanical features of four-pegged and stemmed tibial plate designs under different loads. Methods Three dimensional finite element models of four-pegged and stemmed tibial plate designs implanted on the tibia were constructed. The models were tested under vertical compression loads and rotational loads to compare their biomechanical responses and fixation strength, such as peak contact pressure and contact stress, peak contact sliding distance, displacement of the tibial plate,and peak Mises stress. In order to compare their stress shielding effect on the proximal tibia, four paths in four different locations of the proximal tibial cancellous bone were selected, and the Mises stress in 15 different points of each path were compared. Results The general biomechanical responses of the two designs,as peak contact pressure and contact strain, peak contact sliding distance, displacement of the tibial plate,and peak Mises stress,were similar under vertical loads and rotational loads. The Mises stress of all 15 points in four paths in the cancellous bone below stemmed tibial plate was smaller than that of below fourpegged tibial plate under vertical compression load. Conclusion Four-pegged tibial plate was comparable with stemmed tibial plate in fixation strength. The biomechanical effect of stress shielding in the proximal tibia of the stemmed tibial plate was bigger than that of the four pegged tibial plate.

Objective To identify the pathogenic microorganism by MALDI-TOF MS.Methods A total of 560 strains were resuscitated,which included 260 gram-positive bacteria strains,180 gram-negative bacteria strains,60 yeast-like-fungi strains and 60 enteropathogenic bacteria strains.Comparing MALDI-TOF MS with Vitek2 Compact,the discordant results were validated by 16S rDNA sequencing.Results Comparing MALDI-TOF MS with Vitek2 Compact,the coincidence rate was 94.6％ (246/260) for gram-positive bacteria,96.7％ (174/180) for gram-negative bacteria,95％ (57/60) for yeast-like-fungi,and 93.3％(56/60) for enteropathogenic bacteria Fifteen strains were validated by 16S rDNA gene sequencing.Comparing with sequencing,the coincidence rate of two methods was 66.7％ ( 10/15 ) for MALDI-TOF MS and 26.7％(4/11 ) for Vitek2 Compact,respectively.Conclusion MALDI-TOF MS shows rapid turnaround time and modest reagent costs,and it will be another effective tool for microorganism diagnosis.

OBJECTIVE:To observe the effects of Sodium chloride injection and Glycerine enema on the relief of postoperative defecation pain,edema around wound and incision in patients with complex anal fistula. METHODS:100 patients with complex anal fistula were selected and divided into group A(33 cases),B(33 cases)and C(34 cases)according to random number table. Group A was given Sodium chloride injection 300-500 ml,water bath heated to 35-37℃,into the rectum via enema bag before defecation,and defecated after controlling defecation for 5-10 min. Group B was given Glycerine enema 110 ml into the rectum,and defecated after controlling defecation for 5-10 min. Group C could defecated directly when they felt obvious defecation desire. VAS score of initial defe-cation,defecation frequence and time within 24 h after initial defecation,edema around wound and incision within a week after initial defecation were observed in 3 groups as well as the occurrence of ADR. RESULTS:VAS score of initial defecation,defecation fre-quence and time,edema around wound and incision in group A and B were significantly lower/shorter than in group C,with statistical significance(P<0.05). Above indexes of group B were slightly lower than those of group A,without statistical significance(P>0.05). No obvious ADR was found in group A and B during treatment. CONCLUSIONS:Both Sodium chloride injection and Glycerine enema can relieve postoperative defecation pain in patients with complex anal fistula,and reduce edema around wound and incision with good safety. The two drugs should be selected according to patient’s condition.

Objective To investigate clinical and genetic characteristics of Chinese patients with hereditary spastic paraplegia (HSP).Methods To perform retrospective analyses of clinical data from 179 HSP Han Chinese patients from Xiangya Hospital and National Laboratory of Medical Genetics of China.Results The 179 patients comprised of 114 familial cases (from 41 families with AD inheritance and 37 families with AR inheritance ) and 65 sporadic cases.Genetic anticipation was not found, and nonpenetrance was observed in some HSP families.Male to female ratio was 1.84 to 1.The mean age of onset was ( 18.1 ± 14.0) years, and the mcan duration of disease was ( 12.3 ± 11.5) years.AD-HSP patients had an older age of onset ( ( 19.7 ± 14.0) years) and a longer duration ( ( 17.9 ± 14.4) years) than ARHSP patients (t =2.196 and 4.404, P value were less than 0.05 and 0.01 respectively).Most AD patients manifested as "pure" form, while "complicated" form occurred more frequently in AR patients (F =19.322, P ＜ 0.01 ).Leg stiffness and clumsiness were often the early symptoms at the beginning of the disease, and the most common leg signs were hypertonia, hyperreflexia and pathological reflexes.Other signs included ankle clonus (46.9% ), weakness (42.5% ) and deformities (30.7% ).Ataxia, dysarthria,mental retardation, and foot deformity were more frequently seen in AR-HSP patients than AD-HSP patients,but the frequency of urinary symptoms was higher in AD-HSP patients.Among 65 patients with MRI examination of the head, 13 cases and 9 cases showed corpus callosal dysplasia and cerebellar atrophy,respectively.In addition, spinal cord atrophy was found in 7 of 45 patients undergone MRI examination of the spine.Conclusions Adolescent onset of HSP is common, and more males than females are affected.When compared with AR-HSP, AD-HSP patients have an older age of onset, a longer duration, and more marked urinary symptoms.Most AD-HSP cases are of "pure" form, while most AR-HSP cases manifest as "complicated" form with ataxia, dysarthria, and mental retardation.Dysplasia of corpus callosum is commonly seen in AR-HSP individuals than AD-HSP.HSP manifest gender-related clinical heterogeneity,illustrating the phenomenon of "female protection".

Objective To analyze the clinical efficacy of the laparoscopic breast-conserving surgery combined with radiofrequency ablation to treat the early-stage breast cancer.Methods We collected 55 patients diagnosed early-stage breast cancer in retrospect,which started from January 2014 to December 2016.Twenty-seven of them were performed the laparoscopic breast-conserving surgery combined with radiofrequency ablation while others went through laparoscopic breast-conserving surgery without radiofrequency ablation.Meanwhile,we adopted the student t-test and the chi-square test to compare results of two groups.More specific,the main indexes of this study are including the post-operative local recurrence,the incidence of fat liquefaction or the incision-infection,operation time,post-operative hospital stay and the hospitalization expense.Results The laparoscopic breast-conserving surgery combined with radiofrequency ablation group had low local-recurrence than the laparoscopic breastconserving surgery group (0 and 7.69％).Additionally,there were no statistical differences between two groups in the incidence of fat liquefaction.However,The laparoscopic breast-conserving surgery combined with radiofrequency ablation group had more hospitalization expense than the laparoscopic breast-conserving surgery group [(4.1 ± 0.7) ten thousand yuan and (2.3 ± 0.6) ten thousand yuan,P ＜ 0.05].Conclusions Although the laparoscopic breast-conserving surgery combined with radiofrequency ablation group remarkably increased the hospitalization expense because of the utility of the radiofrequency ablation related apparatus,it may provide the probability of shaving more residual tumor cell and may low down the recurrence,especially not rising up the incidence of the post-operative fat liquefaction.Therefore,this surgery method might be one of the potential developments in the minimal-invasive of early stage breast cancer.

Objective To identify disease-causing mutations in a large panel of Chinese Han patients with hereditary spastic paraplegia(HSP).Methods The coding sequence of the SPG11 gene in the probands of 28 families with ARHSP and 14 sporadic HSP patients was analyzed,and the identified changes in the sequence were tested to exclude being a benign polymorphism by sequencing 200 chromosomes from normal controls.Results Identified 13 causative mutations in SPG11 gene in 7 ARHSP and 3 sporadic HSP The mutations were:c.5977C>T/p.Q1993X、c.4668T>A/p.Y1556X、c.6898_6899delCT/p.L2300AfsX23.38、c.3719_3720delTA/p.11240VfsX263、c.733_734delAT/p.M245VfsX246、c.7088_7089insATTA/p.Y2363X、c.2163_2164insT/p.1722Yfsx731、c.7101-7102insT/p.K2368X、c.6790_6791insC/p.12264PfsX2339、c.654_655delinsG/p.S218RfsX219、c.7151+4_7151+7delAGTA/p.K2384fsX2386、c.6355-21_6355-18delTCT、c.3004C>T/p.G1002X.Among them,12 were novel mutations.The rate of mutation in the SPG11 gene was 25.0%(7/28)in ARHSP,6/6 in ARHSP-TCC and 3/14 in sporadic cases.Conclusions In Chinese Han population,patients with ARHSP-TCC and sporadic HSP-TCC should be screened for SPG11.Sequencing of the SPG11 gene in these patients with is valuable for clinical diagnostic testing.

Objective:To investigate the analgesic effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament (LSQLB) and subcostal transversus abdominis plane block (TAPB) for open liver surgery.Methods:Forty-two patients who underwent elective open liver surgery in Lishui Central Hospital from February 2021 to October 2021 were randomly divided into two groups: LSQLB group (L group, n=21) and TAPB group (T group, n=21). Both groups underwent preoperative ultrasound-guided nerve block, and then LSQLB in group L and subcostal TAPB under the right costal margin in group T. The surgery was subsequently completed under general anesthesia. Patient controlled intravenous analgesia (PCIA) was performed in both groups. The mean arterial pressure (MAP) and heart rate (HR) before skin cutting (T 0), immediately after skin cutting (T 1), at the time of liver exploration (T 2), and at the time of suturing (T 3) were compared between the two groups; the intraoperative sufentanil and remifentanil consumption was recorded; the visual analogue score (VAS) of pain at 2, 8, 16, 24, and 48 h postoperatively and the number of analgesic pump presses and remedial analgesia at 48 h postoperatively were recorded. The incidence of adverse effects such as postoperative hypotonia (lower limb muscle strength ≤grade 4 on the blocked side), hypotension, nausea and vomiting were recorded. Results:The MAP and HR at T 1, T 2 and T 3, the dosage of sufentanil and remifentanil during operation of group L were lower than those of group T(all P<0.05); the VAS score at 2, 8, 16 and 24 hours after operation in group L were lower than those of group T (all P<0.05). The number of analgesic pump presses and remedial analgesia at 48 hours postoperatively in group L were less than those in group T after operation (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions such as postoperative hypokinesia, hypotension, nausea and vomiting in the two groups (all P>0.05). Conclusions:LSQLB for open liver surgery is more hemodynamically stable and has a more definite analgesic effect.

Objective:To observe the effect of hyaluronidase injection into tendon sheath under muscle bone ultrasound guidance in the treatment of tenosynovitis of long head of biceps brachii.Methods:134 patients with tenosynovitis of the long head of biceps brachii treated in SSL Central Hospital of Dongguan from April 2019 to April 2020 were selected as the research objects. All patients were randomly divided into ordinary injection group and ultrasound-assisted injection group, 67 cases in each group. The general injection group was treated with intra-articular injection of hyaluronidase, and the ultrasound-assisted injection group was treated with intra-tendon sheath injection of hyaluronidase under the guidance of muscle and bone ultrasound. Visual Analog Scales (VAS) score, active flexion joint motion (AFROM), shoulder range of motion (ROM), functional score, flexion strength score, nuclear magnetic resonance imaging (MRI) and local tenosynovitis of the long head of biceps brachii (TLHBB)were measured to evaluate the clinical effect and postoperative complications after treatment.Results:There was no significant difference in gender, age, course of disease, periarthritis of shoulder and disuse atrophy of muscles around shoulder between ordinary injection group and ultrasound-assisted injection group ( P>0.05). After treatment, the AFROM, ROM, function score, forward flexion strength score, and middle wedge angle (MWA) of the two groups were significantly higher than those before treatment ( P<0.05), while the VAS score, humeral head diameter (HHD), biceps long head tendon diameter (BTD), and TLBBB were significantly lower than those before treatment ( P<0.05). The AFROM, ROM, function score, and forward flexion strength score, MWA of the ultrasound-assisted injection group were significantly higher than those of the ordinary injection group ( P<0.05), and the VAS score, HHD, BTD, and TLHBB were significantly lower than those of the ordinary injection group ( P<0.05). The total effective rate of the ultrasound-assisted injection group was higher than that of the ordinary injection group (97.01% vs 85.07%, P<0.05). Conclusions:Intra-tendon sheath hyaluronidase injection guided by ultrasound can effectively treat tenosynouitis of the long head of biceps brachii, relieve shoulder pain and improve shoulder motion.

Objective:To compare the cost-effectiveness between open surgery and minimally invasive rotational surgery in patients with benign breast tumor, and to provide a theoretical support for the choice of surgical approach.Methods:The clinical data of 1 389 benign breast tumor patients underwent surgery from January 2017 to January 2020 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Among them, 374 patients were treated with open surgery (open group), and 1 015 patients were treated with minimally invasive rotational surgery (minimally invasive group). The surgery-related and cost-effectiveness analysis indexes were compared between two groups.Results:The operation time, incidence of hematoma/subcutaneous bruising and cosmetic result satisfactory rate in minimally invasive group were significantly higher than those in open group: (37.37 ± 6.66) min vs. (34.58 ± 8.95) min, 10.54% (107/1 015) vs. 5.35% (20/374) and 98.72% (1 002/1 015) vs. 95.99% (359/374); while the incision length, length of hospital stay and pain score were significantly less than those in open group: (5.00 ± 0.00) mm vs. (26.55 ± 4.73) mm, (1.03 ± 0.36) d vs. (2.85 ± 1.99) d, (1.76 ± 1.56) scores vs. (2.72 ± 1.27) scores, and there were statistical differences ( P<0.01). The patients were followed up until May 2022. There were no incision infection, recurrence and residual lesions in the two groups. The total cost and cost-effectiveness ratio in minimally invasive group were significantly lower than those in open group: (6 553 ± 1 150) yuan vs. (7 965 ± 3 323) yuan and 71.10 ± 13.61 vs. 88.96 ± 37.48, the benefit score was significantly higher than that in open group: (96.50 ± 3.89) scores vs. (88.92 ± 6.39) scores, and there were statistical differences ( P<0.01). Conclusions:Compared with open surgery, minimally invasive rotational surgery is less costly and more benefits, so minimally invasive surgery should be the preferred surgical procedure for benign breast tumor.

Objective: To evaluate the efficacy of radiofrequency ablation in breast-conserving surgery followed neoadjuvant chemotherapy. Methods: Retrospective analysis of 30 cases of breast cancer patients admitted to Beijing Friendship Hospital, Capital Medical University from April 2015 to September 2018. The average age was 54.3 years and the range was 28 to 70 years. For breast invasive ductal cancer, patients underwent breast-conserving surgery after neoadjuvant chemotherapy, and then received radiofrequency ablation. The clinical and pathological characteristics, postoperative complications, recurrence and metastasis, and cosmetic effects were observed. Results: All 30 patients with breast-conserving surgery successfully completed radiofrequency ablation. The average outpatient follow-up was 22.5 months, ranging from 2 to 43 months, without local recurrence or metastasis; skin burns occurred in 2 cases (6.67%), and solid nodules formed in situ in 6 cases (20.00%); cosmetic satisfaction rate was 86.67% (26/30). Conclusions The radiofrequency ablation techniques applied in breast-conserving surgery have a high rate of technical success with relative low complication rates. And the radiofrequency ablation techniques may improve the cosmetic results after breast-conserving surgery and enhance local control.