Objective To investigate the effect of through frontal keyhole approach neuroendoscopic surgery of basal ganglia hemorrhage on nerve conduction tract and prognosis.Methods 56 patients with hypertensive basal ganglia hemorrhage treated in our department from October 2017 to October 2023 were selected and divided into observation group and control group.Among them,28 patients in the control group underwent microscopic surgery through temporal cortex approach,while 28 patients in the observation group underwent endoscopic surgery through frontal keyhole approach.Fractional anisotropy and activities of daily living were compared between the two groups after operation.Results The proportion of FA Ⅰ grade in observation group was 88.9％and 70.0％in GCS Ⅰ grade and GCS Ⅱgrade patients,respectively,while in control group it was 75.0％and 41.7％.The proportion of ADL Ⅰand Ⅱ grade in observation group was 94.4％and 70.0％in GCS Ⅰ grade and GCS Ⅱ grade patients,respectively,whereas in control group it was 81.3％and 41.7％.The integrity of the corticospinal tract and activities of daily living in observation group were better than those in control group,with statistical significance(P＜0.05).Conclusion The surgery of hypertensive basal ganglia hemorrhage with neuroendoscopy through frontal keyhole approach has little influence on nerve conduction tract and the prognosis was better than traditional microscopic surgery through temporal cortex approach.

Objective To investigate the effect of through frontal keyhole approach neuroendoscopic surgery of basal ganglia hemorrhage on nerve conduction tract and prognosis.Methods 56 patients with hypertensive basal ganglia hemorrhage treated in our department from October 2017 to October 2023 were selected and divided into observation group and control group.Among them,28 patients in the control group underwent microscopic surgery through temporal cortex approach,while 28 patients in the observation group underwent endoscopic surgery through frontal keyhole approach.Fractional anisotropy and activities of daily living were compared between the two groups after operation.Results The proportion of FA Ⅰ grade in observation group was 88.9％and 70.0％in GCS Ⅰ grade and GCS Ⅱgrade patients,respectively,while in control group it was 75.0％and 41.7％.The proportion of ADL Ⅰand Ⅱ grade in observation group was 94.4％and 70.0％in GCS Ⅰ grade and GCS Ⅱ grade patients,respectively,whereas in control group it was 81.3％and 41.7％.The integrity of the corticospinal tract and activities of daily living in observation group were better than those in control group,with statistical significance(P＜0.05).Conclusion The surgery of hypertensive basal ganglia hemorrhage with neuroendoscopy through frontal keyhole approach has little influence on nerve conduction tract and the prognosis was better than traditional microscopic surgery through temporal cortex approach.

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.

Abstract Prevention and control of myopia requires comprehensive measures. Based on the system established earlier, the system is revised and upgraded. The original system emphasizes comprehensive measures and proposes to focus on both the symptoms and root causes. These measures are summarized into six aspects, three address the root cause measures including health education, glasses optics and visual environment, and three address symptoms measures including eye exercises, physical therapy and drugs. The paper is comprehensively supplemented and analyzes the primary and the secondary, and promotes physical therapy from treating the symptoms to treat both the symptoms and the root causes. These improvement measures will help promote the prevention and control of myopia in children and adolescents.

Objective:To investigate the specific method, efficacy and safety of intrathecal baclofen (ITB) in the treatment of moderate and severe spasticity.Methods:The clinical features, response to ITB trial, clinical outcomes and treatment-related complications after baclofen pump implantation surgery were retrospectively analyzed in patients with moderate to severe spasticity who received ITB treatment in Hong Kong University Shenzhen Hospital from August 2022 to August 2023.Results:The study included 22 patients with moderate to severe spasticity, of whom 18 patients (81.8%) were effective in ITB trial. For these patients with effective trial, the lowest mean Modified Ashworth Scale (MAS) score of lower extremity muscle groups after ITB bolus injection was decreased significantly compared with the baseline mean value before injection (1.29±0.81 vs 3.31±1.18 , t=11.364, P<0.001), and the M/H amplitude ratio of soleus H-reflex at 4 hours after ITB bolus injection was significantly higher than the baseline value (9.61±4.66 vs 3.83±2.69, t=7.780, P<0.001). Among the 18 patients with effective ITB trial, 10 patients received baclofen pump implantation surgery with the informed consent of the patients or their guardians. Compared with the 8 patients without surgery, the baseline mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was higher (3.71±1.06 vs 2.83±1.16, F=5.645, P<0.05), the maximum reduction of mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was greater (2.61±0.99 vs 1.30±0.64, F=20.696, P<0.001). In 10 patients who received baclofen pump implantation surgery, the mean MAS score of lower limb muscle groups was significantly decreased in the first and sixth months after surgery compared with the baseline mean value before surgery (1.64±0.91, 1.16±0.89 and 3.71±1.06, F=39.946, P<0.001). Among them, 2 patients were followed up to 12 months after surgery, 2 patients were followed up to 18 months after surgery, and the mean MAS score of their lower limb muscle groups showed continuous improvement, and 1 patient with cerebral palsy combined with lower urinary tract hyperactive syndrome also showed significant improvement of urgent urinary incontinence after surgery. Up to the last follow-up, the daily dose of baclofen in 10 patients receiving baclofen pump implantation was (143.60±96.24) μg, and no treatment-related complications occurred. Conclusions:ITB can effectively relieve spasticity symptoms and other related neurological dysfunction in patients with moderate and severe spasticity, and the efficacy can be maintained for a long time, and treatment-related complications are rare. Preoperative ITB trial is helpful to screen out patients more suitable for baclofen pump implantation. Patients with higher grade of spasticity at baseline and better efficacy of ITB trial are more suitable for baclofen pump implantation. The soleus H reflex can effectively reflect the change of stretch reflex of lower limb muscle groups in patients with spasticity treated by ITB, and can be used to evaluate the treatment effect of ITB.

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 explore the epidemiological characteristic of a COVID-19 outbreak caused by 2019-nCoV Omicron variant BF.7 and other provinces imported in Shenzhen and analyze transmission chains and characteristics. Methods: Field epidemiological survey was conducted to identify the transmission chain, analyze the generation relationship among the cases. The 2019-nCoV nucleic acid positive samples were used for gene sequencing. Results: From 8 to 23 October, 2022, a total of 196 cases of COVID-19 were reported in Shenzhen, all the cases had epidemiological links. In the cases, 100 were men and 96 were women, with a median of age, M (Q₁, Q₃) was 33(25, 46) years. The outbreak was caused by traverlers initial cases infected with 2019-nCoV who returned to Shenzhen after traveling outside of Guangdong Province.There were four transmission chains, including the transmission in place of residence and neighbourhood, affecting 8 persons, transmission in social activity in the evening on 7 October, affecting 65 persons, transmission in work place on 8 October, affecting 48 persons, and transmission in a building near the work place, affecting 74 persons. The median of the incubation period of the infection, M (Q₁, Q₃) was 1.44 (1.11, 2.17) days. The incubation period of indoor exposure less than that of the outdoor exposure, M (Q₁, Q₃) was 1.38 (1.06, 1.84) and 1.95 (1.22, 2.99) days, respcetively (Wald χ²=10.27, P=0.001). With the increase of case generation, the number and probability of gene mutation increased. In the same transmission chain, the proportion of having 1-3 mutation sites was high in the cases in the first generation. Conclusions: The transmission chains were clear in this epidemic. The incubation period of Omicron variant BF.7 infection was shorter, the transmission speed was faster, and the gene mutation rate was higher. It is necessary to conduct prompt response and strict disease control when epidemic occurs.
Male ; Humans ; Female ; SARS-CoV-2 ; COVID-19/epidemiology* ; Disease Outbreaks ; Epidemics ; China/epidemiology*

OBJECTIVE To establish the fingerprints of Kangfuyan capsules and carry out chemical pattern recognition analysis，and simultaneously determine the contents of five components so as to promote the quality standard of the drug. METHODS High performance liquid chromatography （HPLC）fingerprints of 11 batches of Kangfuyan capsules （S1-S11）were established by Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition）；identification and attribution analysis of chromatographic peaks were carried out by comparison with the chromatograms of the reference substance and the decoction pieces of single ingredient. SPSS 26.0 and SIMCA 14.1 software were used for cluster analysis and principal component analysis. HPLC method was used to determine the contents of matrine ，phellodendrine chloride ，rutin，forsythoside A and berberine hydrochloride. RESULTS There were 29 common peaks in the fingerprints for 11 batches of samples ，and the similarity was higher than 0.99. A total of 5 chromatographic peaks were identified ，which are matrine （peak 3），phellodendron chloride （peak 14），rutin （peak 20），forsythiaside A （peak 22） and berberine hydrochloride （peak 28）. The results of cluster analysis and principal component analysis showed that S 1-S9 were clustered into one category ，and S 10 and S 11 were clustered into another category. The contents of above 5 components were 29.320 5-60.144 3，0.621 6-1.076 6，1.025 9-2.830 5，2.899 3-6.212 7 and 4.425 1-8.581 6 mg/g， respectively. CONCLUSIONS The established fingerprint and content determination method are stable and reliable ，and can provide reference for the quality control of the preparation in combination with chemical pattern recognition analysis.

OBJECTIVE： To evaluate the efficacy and safety of apremilast in the treatment of moderate-to-severe plaque psoriasis systematically. METHODS： Retrieved from PubMed， Embase， Cochrane Library， VIP， CNKI and CBM， RCTs about apremilast or apremilast combined with other drugs （trial group） versus placebo （control group） in the treatment of moderate- to-severe plaque psoriasis were collected. Meta-analysis was conducted by using Rev Man 5.3 statistical software after literature screening， data extraction and quality evaluation with bias risk evaluation tool of Cochrane System Evaluator Manual 5.1.0. RESULTS： Totally 7 studies were included， involving 2 332 patients. Results of Meta-analysis showed that case number of psoriasis assessment and severity index （PASI） decreased by 75％ （PASI 75％） [OR＝6.44，95％CI（4.90，8.45），P＜0.000 01]， PASI 90％ [OR＝8.13， 95％CI（4.65， 14.22）， P＜0.000 01] and sPGA 0 or 1 [OR＝3.89，95％CI（3.00，5.05），P＜0.000 01]， the incidence of ADR [OR＝1.87，95％CI（1.44，2.43）， P＜0.000 01] in trial group were significantly more or higher than control group. Subgroup analysis by apremilast dose showed that case number of 20 mg PASI 75％ [OR＝4.72，95％CI（2.77，8.05），P＜0.000 01]， 30 mg PASI 75％ [OR＝7.05，95％CI（5.13，9.69），P＜0.000 01]， 20 mg PASI 90％ [OR＝4.27，95％CI（1.80，10.09），P＝0.001]， 30 mg PASI 90％ [OR＝11.11，95％CI（5.27，23.43），P＜0.000 01]， 20 mg sPGA 0 or 1 [OR＝2.82，95％CI（1.51，5.26），P＝0.001]， 30 mg sPGA 0 or 1 [OR＝4.13，95％CI（3.10，5.50），P＜0.000 01]， the incidence of 30 mg ADR [OR＝1.94，95％CI（1.51，2.49），P＜0.000 01] in trial group were significantly more or higher than control group. There was no statistical significance in the incidence of serious ADR [OR＝1.27，95％CI（0.77，2.07），P＝0.35] or case number of ADR leading to withdrawal [OR＝1.48，95％CI（1.00，2.20），P＝0.05] between 2 groups. CONCLUSIONS： Apremilast is effective for moderate-to-severe plaque psoriasis in dose-dependent manner and improve the quality of life， but increase the incidence of ADR.

OBJECTIVE:To systematically review the efficacy of Compound danshen dripping pill or Compound danshen tablets for chronic hepatitis B complicated with hepatic fibrosis,and to provide evidence-based reference for clinical treatment.METHODS:Retrieved from PubMed,Cochrane Library,EMBase,Medline,Wanfang database,VIP,CJFD and CBM database,randomized controlled trials (RCTs) about Compound danshen dripping pills or tablets combined with entecavir(trial group) vs.entecavir alone (control group) for chronic hepatitis B complicated with hepatic fibrosis were collected.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation according to Cochrane systematic evaluation manual 5.1.0.RESULTS:A total of 9 RCTs were enrolled,including 714 patients.The results of Meta-analysis showed that ALT [SMD=-0.44,95％CI(-0.86,-0.01),P=0.04],HA [SMD=-1.53,95％CI(-2.28,-0.79),P＜0.001],LN [SMD=-0.93,95％CI(-1.41,-0.46),P＜0.001],CⅣ [SMD=-1.38,95％CI(-2.13,-0.63),P＜0.001] and PCⅢ [SMD=-1.42,95％ CI (-1.60,-1.23),P＜0.001] of trial group were significantly lower than those of control group;HBV-DNA negative rate [OR=3.73,95 ％ CI (2.14,6.49),P ＜ 0.001] was significantly higher than control group,with statistical significance.CONCLUSIONS:Compound danshen dripping pills or tablets can not only improve liver function and liver fibrosis in chronic hepatitis B patients with hepatic fibrosis,but also improve the antiviral effect.