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.

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 analyze the clinical characteristics of critical patients with coronavirus disease 2019 (COVID-19), build an early warning model for severe/critical type, and aim at providing reference for the prediction of severe/critical COVID-19.Methods:The clinical data of COVID-19 patients treated in the Second People' Hospital of Fuyang City from January 20th to February 18th in 2020 were retrospective analyzed, including the demographic and epidemiological date, vital signs and hematology indexes, etc. on admission. Patients were divided into the normal type (set as normal group) and severe/critical type (set as severe group) according to the COVID-19 treatment plan classification standard published by National Health Commission of the People's Republic of China. The differences between two groups were compared, and the variables with statistical significance were incorporated in the multivariate binary unconditional Logistic regression analysis to screen the risk factors of severe/critical type. Risk factors were summarized to establish an early warning model, and the receiver operating characteristic (ROC) curve was carried out to evaluate the significance of the early warning model in the screening of critically COVID-19.Results:A total of 155 patients with COVID-19 were admitted, including 125 patients of normal type and 30 patients of severe/critical type. ① Compared with normal group, patients in severe group were older, and with higher proportion of basic diseases, higher body mass index (BMI), higher incidence of tachypnea, persistent high fever, peripheral blood oxygen saturation (SpO 2) < 0.95, while the white blood cell count (WBC), CD4 + T lymphocyte, CD8 + T lymphocyte, lymphocyte count (LYM) were decreased obviously, the levels of interleukin-6 (IL-6), C-reactive protein (CRP) and serum amyloid a protein (SAA), and CT showed higher incidence of multi-pulmonary lobe lesions. There were no significant differences of gender, travel history from Wuhan, smoking history, shock index (SI) and CD4 +/CD8 + ratio between the two groups. ② Multivariate Logistic regression analysis showed that age ≥60 years old [odds ratio ( OR) = 1.620, P = 0.031], combined with underlying diseases ( OR = 1.521, P = 0.044), persistent high fever ( OR = 2.469, P = 0.014), WBC < 2.0×10 9/L and/or LYM < 0.4×10 9/L ( OR = 3.079, P = 0.006), pulmonary multilobar lesions ( OR = 1.367, P = 0.047), and IL-6 ≥ 30 ng/L ( OR = 2.426, P = 0.010) were the risk factors of severe/critical COVID-19. ③ The OR value corresponding to each risk factors were scored by rounding. Two points were scored for age≥60 years old, with underlying diseases, persistent high fever and IL-6 ≥ 30 ng/L, 3 points for WBC < 2.0×10 9/L and/or LYM < 0.4×10 9/L, 1 point for pulmonary multilobar lesions, and totally calculated as early warning model scores. The early warning model score of the severe group was significantly higher than that of the normal group (9.33±2.79 vs. 5.04±2.38, t = 9.010, P = 0.001). ④ The ROC curve analysis showed the area under ROC curve (AUC) of early warning model on the early screening of severe/critical patients in COVID-19 was 0.944, and 95% confidence interval (95% CI) was 0.903-0.985; and the sensitivity and specificity were 93.3% and 72.0% respectively while the cut-off was 6.5. Conclusions:There are many differences between severe/critical and mild COVID-19 patients. The establishment of early warning model could help to screen severe/critical patients at an early stage, with certain significance for guiding treatment.

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.