Objective To investigate the clinical efficacy of Zhuang medical sinew therapy forcervical spondylotic radiculopathy and provide reliable experimental data and scientific evidence for the establishment of clinical technical operation standardization.Method Eighty patients with cervical spondylotic radiculopathy were randomly allocated to treatment and control groups, 40 cases each.The control group took Jingfukang granules with hot water and the treatment group received Zhuang medical sinew therapy.The therapeutic effects were compared after one course of treatment.The 20-point scale score and the VAS score were recorded in the patients before and after treatment.Result Thirty-eight patients in the treatment group and 36 patients in the control group completed the required treatments. The total efficacy rate was 92.1% in the treatment group and 72.2% in the control group;there was a statistically significant difference between the twogroups(P<0.05).There were statistically significant post-treatment differences in the Japanese 20-point scale score and the VAS score between the two groups (P<0.05).Theresults showed that the Japanese 20-point scale score and the VAS score improved more in thetreatment group.Conclusion Zhuang medical sinewtherapy has a marked effect oncervical spondylotic radiculopathy.

Objective To evaluate the safety and accuracy in treating the avascular necrosis of femoral head (ANFH) with computer navigated core decompression and bone marrow stream cell transportation and to guide the clinical treatment. Method Within the prospective study, 36 patients suffered ANFH (ARCO Ⅰ - Ⅱ ) and treated with computer navigated core decompression and bone marrow stream cell transportation were studied. The operating time, blood loss, x ray exposure, preoperative and 6 week postoperative Harris score and imaging evaluation were recorded and compared with conventional core decompression and bone marrow stream cell transportation. Results There were no obvious difference between the two groups in imaging evaluation, operating time and blood loss ( P ＞ 0. 05 ). There were statistical difference between the two groups in x ray exposure and 6 week postoperative Harris score [ (4. 1 ± 1.8 ) s,(13.6±3.2)s,P ＜0. 01,and89.4±10. 1,83.1±10. 5, P ＜0.01]. Conclusion Computer navigated core decompression and bone marrow stream cell transportation have good security and precision in treating early stage ANFH.

BACKGROUND:Cartilage defects are one of the major clinical challenges faced by orthopedic surgeons.Tissue engineering is an interdisciplinary approach that combines knowledge of engineering and cell biology to provide new ideas and approaches for the repair of cartilage defects. OBJECTIVE:To prepare a multi-component composite scaffold based on silk fibroin,gelatin,and chitosan to screen for a three-dimensional porous scaffold suitable for cartilage regeneration by evaluating its physicochemical properties and biological performance. METHODS:Four groups of porous scaffolds were prepared by vacuum freeze-drying method using silk fibroin,gelatin and chitosan as the base materials,namely chitosan/gelatin scaffold,silk fibroin/chitosan scaffold,silk fibroin/gelatin scaffold and silk fibroin/chitosan/gelatin scaffold.The suitable cartilage scaffolds were screened by scanning electron microscopy,X-ray diffractometer,porosity,water absorption and swelling rate,biodegradation rate and mechanical property detection.Then cartilage scaffolds were co-cultured with chondrocytes isolated and extracted from patients with osteoarthritis.The feasibility of porous scaffolds for cartilage injury repair was evaluated in vitro by cell adhesion rate assay,cell live-dead staining and cell activity proliferation assay. RESULTS AND CONCLUSION:(1)All four groups of scaffolds had porous structures.The comprehensive physical performance test results showed that the silk fibroin/gelatin/chitosan scaffold was more in line with the requirements of cartilage defect repair.This scaffold had a pore size of(176.00±53.68)μm,the porosity of(80.15±2.57)%,and water absorption and swelling rate of(3 712±358)%.After immersion in PBS containing lysozyme for 28 days in vitro,the biodegradation rate was(46.87±3.25)%,and it had good mechanical properties.(2)Chondrocytes could adhere well on the silk fibroin/gelatin/chitosan scaffold,and the cell adhesion rate increased with time.CCK8 and live/dead cell double staining results showed that silk fibroin/gelatin/chitosan scaffold had good biocompatibility and low cytotoxicity.(3)The results showed that silk fibroin/gelatin/chitosan scaffold had a highly hydrated 3D structure,suitable pore size and porosity,good biodegradability and superior mechanical properties,which can provide a good reticular skeleton and microenvironment for nutrient transport and chondrocyte attachment and proliferation.

Objective To investigate the incidence of osteonecrosis of the femoral head (ONFH) in divers of Dalian.Methods From January 2010 to December 2010,all registered 855 divers in Dalian were enrolled in this study.All divers underwent a unified medical examination and a questionnaire including height,weight,blood pressure and hip inspection.Radiological examination (anteroposterior and frog position)was used for all divers.Suspicious persons with hip pain but normal X-ray performance were confirmed by MRI.Results Sixty-eight divers were confirmed as ONFH,and the incidence of ONFH in divers of Dalian was 7.95％.According to the Ficat classification,12 patients (12 hips) were in Phase 1,40 patients (47 hips)in phase Ⅱ,3 patients (3 hips) in phase Ⅲ,13 patients (15 hips) in phase Ⅳ.The mean age of divers was 32.6+5.5 years (range,18-55 years).The onset ages of most patients ranged from 30 years to 50 years,accounted for 83.82％ (57/68).Among all patients,primary school education accounted for 10.58％ (38/359),junior high school education 6.28％ (28/446),high school education 4.26％ (2/47),university education 0 (0/3); seniority less than 5 years accounted for 4.55％ (20/440),6-10 years 9.69％ (28/289),11-15 years 13.04％ (12/92),16-20 years 21.05％ (4/19),more than 20 years 26.67％ (4/15); self-employed accounted for 11.88％ (19/160),private enterprise 8.41％ (38/452),and national enterprise 4.53％ (11/243).Conclusion The incidence of ONFH is high in divers of Dalian,which is different in terms of age,seniority,level of education,enterprise nature.

Objective To explore the feasibility,safety and efficacy of customized porous tantalum acetabular patch made by three-dimensional (3D) printing technique in treating adult developmental dysplasia of the hip (DDH).Methods Eight adult patients with Crowe Ⅰ type DDH (2 men and 6 women,with a mean age of 43.75±7.81 years,range 33-58 years) who were treated with 3D printed customized porous tantalum acetabular patch hip reconstruction from January 2017 to September 2017 were included.The 3D printing technique was used for reconstructing and designing the optimal acetabular patch for the personalized hip joint of each patient.The acetabular patch was subjected to porous processing and finite element analysis until the biomechanical requirements were met.The 3D printing of porous tantalum acetabular patch and post-processing was subsequently performed.The acetabular patch was implanted through the anterior approach of the hip joint.The operative duration,intraoperative blood loss and complications were recorded.All the included patients were followed up at 1.5,3 and 6 months postoperatively.Pain was assessed using the visual analog scale (VAS),and the hip joint function was evaluated using the Harris score and gait analysis.The patients underwent anterior-posterior radiography and 3D computed tomography of the hip joint aiming to observe the position of the acetabular patch and osteoarthritis progression.Results The mean operative duration was 1.13±0.23 h,and the mean blood loss was 114.17±41.22 ml.All patients were followed up for 6 to 12 months,with an average of 8.2 months.The mean lateral central-edge angle and anterior central-edge angle ranged from 9.83°±5.34° preoperatively to 32.67°±2.53° postoperatively and from 3.83°± 2.79° preoperatively to 21.67°± 1.87° postoperatively,respectively.The rate of acetabular coverage increased from 57.33％±7.97％ preoperatively to 87.33％±4.56％ postoperatively.The VAS and Harris scores ranged from 2.92± 0.79 preoperatively to 0.83±0.72 postoperatively and from 69.67±4.62 preoperatively to 84.25±4.14 postoperatively with statistically significant difference,respectively.The results of gait analysis showed that the step speed,stride,the range of motion of hip and knee were better than that preoperatively.The images suggested a close contact between the tantalum acetabular patch and the iliac bone without loosening and progress of osteoarthritis in hip joint.Conclusion 3D printed customized porous tantalum acetabular patch could reconstruct the defect of acetabular,increase the coverage,and delay the progress of osteoarthritis of the hip joint.This method could reduce the difficulty of hip reconstruction,and the patients could obtain better joint function at the early stage.

Objective To explore the impact of sex on the efficacy of first-line programmed death-1 (PD-1) blockade plus chemotherapy in patients with advanced lung adenocarcinoma and its potential biological mechanisms. Methods The clinical and pathological characteristics and follow-up data of 163 patients with advanced lung adenocarcinoma without driver gene alterations at Shanghai Pulmonary Hospital affiliated to Tongji University from October 2018 to October 2023 were retrospectively collected. Among them, 103 patients received first-line PD-1 blockade plus chemotherapy (51 males and 52 females) and 60 patients received first-line standard platinum-based doublet chemotherapy (39 males and 21 females). Patients were divided into male group and female group. Clinical characteristics, efficacy, progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Kaplan-Meier method was used to plot the survival curves of male and female patients, and log-rank test was used for significance evaluation. Cox proportional hazards model was used to analyze the factors influencing PFS and OS. Multiplex immunofluorescence (mIF) assays were used to analyze the differences of protein expression levels of programmed death-ligand 1 (PD-L1), CD8, CD68, CD4, and FOXP3 between male and female groups in baseline tumor sample. Results In patients receiving first-line PD-1 blockade plus chemotherapy, the median PFS in female group and male group was 13.0 months and 6.8 months, respectively (HR＝0.39, 95%CI 0.25-0.62; P＜0.01). The median OS in female group and male group was 46.2 months and 17.3 months, respectively (HR＝0.30, 95%CI 0.18-0.50; P＜0.01). In patients receiving first-line chemotherapy, the median PFS in female group and male group was 5.7 months and 5.5 months, respectively (P＞0.05); the median OS in female group and male group was 21.7 months and 17.7 months, respectively (P＞0.05). The results of the Cox proportional hazards model showed that sex was an independent factor influencing PFS and OS in patients receiving first-line PD-1 blockade plus chemotherapy (P＜0.05). The results of mIF showed that pretreatment tumor samples of female patients had a significantly higher expression level of CD8 than male patients (P＜0.05), while the expression level of PD-L1, CD68, CD4 and FOXP3 was similar between female and male groups. Conclusions Compared to male patients, female patients with advanced lung adenocarcinoma benefit more from the first-line PD-1 blockade plus chemotherapy. The increased expression level of CD8 in pretreatment tumor samples of female patients would be the potential mechanism.

OBJECTIVE To investigate the clinical effect of Budigafol combined with Staphylococcus and neisseria tablets in maintenance treatment of patients with stable moderate to severe chronic obstructive pulmonary disease （COPD）. METHODS A total of 122 patients with stable moderate to severe COPD who were admitted to the infections diseases ward of the department of respiratory and critical care medicine in our hospital from October 1， 2021 to January 31， 2023 were divided into control group （n＝61） and observation group （n＝61） according to the random number table method. Patients in the control group were treated with Budigafol inhalation aerosol alone （2 presses each time， twice a day）， and patients in the observation group were treated with Staphylococcus and neisseria tablets （1.2 mg each time， 3 times a day） on the basis of the control group. The treatment course of both groups was 3 months. The quality of life， exercise tolerance， lung function， inflammatory indexes， immune function， as well as the number of acute attacks of COPD and the occurrence of adverse reactions were compared between the two groups before and after treatment. RESULTS Control group and observation group shed 12 and 9 patients， respectively. After treatment， the 6 minute walking distance of the two groups of patients was significantly prolonged compared with that before treatment （P＜0.05）. The COPD assessment test questionnaire score， St George’s respiratory questionnaire score， the ratio of residual volume to total lung capacity， the fractional exhaled nitric oxide， the serum levels of C-reactive protein and interleukin-6 were significantly E-mail：13956685295@163.com decreased compared with those before treatment （P＜0.05）. The forced expiratory volume in one second （FEV1）， the ratio E-mail：13966580920@163.com of FEV1 to forced vital capacity， the percentage of the measured value of carbon monoxide diffusion capacity to the predicted value， and the percentage of the measured value of FEV1 to the predicted value were significantly increased compared with those before treatment （P＜0.05）. The improvement of the above indicators in the observation group was significantly better than that in the control group （P＜0.05）. Compared with before treatment， there was no statistical significance in the immune function indexes of the control group or the serum levels of immunoglobulin A （IgA） and IgM in the observation group after treatment （P＞0.05）. The percentages of CD3+ ， CD4+ ， B lymphocytes and natural killer cells， the levels of CD4+/CD8+ and IgG were significantly increased in the observation group （P＜ 0.05）， the percentage of CD8+ cells was significantly decreased （P＜0.05）， and the improvement degree of the observation group was significantly better than that of the control group （P＜0.05）. There was no significant difference in the number of acute exacerbations of COPD during the follow-up period and the incidence of adverse events during treatment between the two groups （P＞0.05）. CONCLUSIONS Budigafol combined with Staphylococcus and neisseria tablets can effectively improve the immune function of patients with stable moderate to severe COPD， further reduce the level of inflammation， and improve their exercise tolerance and their quality of life with good safety.