BACKGROUND:To repair and reconstruct the joint capsule and surrounding ligaments is one of effective methods against displacement and dislocation after total hip arthroplasty. In recent years, anterolateral total hip arthroplasty has been widely used, but little is reported on the anatomic features of the anterolateral hip joint capsule and iliofemoral ligament. OBJECTIVE:To investigate the anatomic features of the anterolateral hip joint capsule and iliofemoral ligaments, thereby providing anatomic evidence for selecting and optimizing the approach for total hip arthroplasty and for clinical practice. METHODS:Thirty adult cadaver hips fixed with formalin were used for this study. The anterolateral hip joint capsule and the iliofemoral ligaments were dissected and anterolateral hip joint capsules were divided into three sections and nine parts. The average thickness of each part and the average height and width of each section were measured. The anterolateral hip joint capsule was observed by its beginning and ending, course, branch and histological features. RESULTS AND CONCLUSION:The anterolateral hip joint capsule was tightly connected with the iliofemoral ligaments to form a complex. The thickness of the capsule was varied. The thinnest parts of the complex were BI and BII. In addition, the average height and width of each section were different. The joint capsule originating from the anterior inferior iliac spine and acetabulum was divided into three branches and fixed on the intertrochanteric line. Understanding of the anterolateral hip joint capsule and iliofemoral ligaments may make for the approach selection, design and optimization of total hip arthroplasty.

BACKGROUND:Interleukin-12 (IL-12) may function as an immune regulator in the pathogenesis of osteoarticular tuberculosis. OBJECTIVE:To explore the association of single-nucleotide polymorphisms in IL-12A rs568408 G/A and IL-12B rs3212227 A/C with susceptibility to osteoarticular tuberculosis and serum interleukin-12 levels in Guangxi Zhuang population. METHODS:The single-nucleotide polymorphisms in IL-12A rs568408 G/A and IL-12B rs3212227 A/C polymorphisms were detected by polymerase chain reaction-single base extension technique and direct DNA sequencing in 150 patients with osteoarticular tuberculosis (disease group) and 165 healthy individuals (control group) in Guangxi Zhuang population. The genotype and al ele frequencies of IL-12 and the relationship of genotypes to the susceptibility to osteoarticular tuberculosis were analyzed. In addition, the association of genotypes of single-nucleotide polymorphisms in IL-12A rs568408 G/A and IL-12B rs3212227 A/C with serum IL-12 levels were analyzed. RESULTS AND CONCLUSION:There was no significant difference in the genotype and al ele frequencies of IL-12A rs568408 G/A and IL-12B rs3212227 A/C between the disease group and the control group (P>0.05). Moreover, there was no difference in four haplotypes of IL-12 gene between the disease group and the control group (P>0.05). Serum IL-12 levels in subjects with osteoarticular tuberculosis carrying the variant rs568408 GA/AA genotypes and wild-type rs568408 GG genotypes were similar (P>0.05). Similarly, there was no significant difference in serum IL-12 levels between subjects with osteoarticular tuberculosis carrying the variant rs3212227 AC/CC genotypes and wild-type rs3212227 AA genotypes (P>0.05). These findings suggest that the single-nucleotide polymorphisms in IL-12A rs568408 G/A and IL-12B rs3212227 A/C polymorphisms are not associated with susceptibility to osteoarticular tuberculosis in Guangxi Zhuang population.

Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

Objective To explore the current status of clinical ability in higher vocational college nursing students, and the necessity of action oriented practice examination model in higher vocational college nursing teaching. Methods From January to December 2015, a total of 30 higher health vocational colleges which set nursing major in 17 provinces (municipality directly under the Central Government) were investigated. Totally 409 nursing interns were investigated by self-designed Clinical Practice Questionnaire Survey for Higher Vocational College Nursing Students, and 83 nursing staff were interviewed on the need of the abilities in nursing students. One investigation unit in each province or city was contacted, who was responsible for the release, recycle and mail of the questionnaires. The differences in the status score and the demand score of nursing students were compared, and the correlation among various dimensions were analyzed. Results There were statistical significance in the differences of scores in professional ability, method ability, social ability and each dimension of nursing students' clinical abilities (P<0.01). The result of correlation analysis indicated that there was no correlation between method ability and professional ability (P>0.05), on the other side, all the other dimensions were positively correlated (P<0.01). Conclusions The clinical ability in higher vocational college nursing students are correlated with professional ability, method ability and social ability. Thus, action oriented practice examination model formed according to that result have relatively feasibility.

Objective:To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation (LT) recipients to provide rationales for early identification of delirium and constructing the related models.Methods:The authors used the "肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and "liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords, searching Wanfang data, China Biomedical Literature Database, CNKI, PubMed, Embase, Web of Science, Cochrane Library, BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients. The researchers independently performed literature screening, methodological evaluation and data extraction. And RevMan 5.4 and State16.0 software were employed for data processing.Results:A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies. Meta-analysis showed that the incidence of POD was 23%(1151/5003). The statistically significant risk factors included preoperative blood ammonia concentration >46 mmol/L ( OR=3.51, 95% CI: 1.53-8.09, P<0.001), model for end-stage liver disease (MELD) score >15 points ( OR=4.24, 95% CI: 2.51-7.16, P<0.001), preoperative hepatic encephalopathy ( OR=3.00, 95% CI: 2.09-4.31, P<0.001), preoperative dosing of diuretics ( OR=2.36, 95% CI: 1.38-4.04, P<0.001), history of alcoholism ( OR=3.16, 95% CI: 1.06-9.40, P=0.040), longer anhepatic period ( OR=1.04, 95% CI: 1.03-1.06, P<0.001) and elevated aspartate transaminase concentration at Day 1 post-operation ( OR=1.33, 95% CI: 1.15-1.53, P<0.001). Conclusions:Preoperative blood ammonia concentration >46 mmol/L, MELD score >15, hepatic encephalopathy, dosing of diuretic, a history of alcoholism, longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT. Postoperative reintubation is not a risk factor for postoperative delirium.

Objective:To analyze qualitative research on safety culture cognition of medical staff and patients in medical institutions, for references to promote the development of safety culture in medical institutions.Methods:This study searched English databases such as PubMed and Embase, as well as Chinese databases such as CNKI and Wanfang, to collect qualitative research related literature on the safety culture cognition of medical staff and patients in medical institutions. The search period was from database establishment to July 15, 2023. The inclusion and exclusion criteria for literature, and the Australian JBI critical appraisal tool for qualitative research were used to screen the literature, and a meta-synthesis method was used to integrate and analyze the research results.Results:A total of 13 articles were included, and 30 research results were extracted and integrated into three levels: individual, organizational, and interpersonal. Among them, the individual level included three categories: responsibility and ability, personal factors, and patient factors. The organizational level included five categories: patient safety as the primary principle, management level, regulations and processes, work environment, and safety culture atmosphere. The interpersonal level included two categories: cooperation and communication.Conclusions:The development and construction of safety culture were influenced by various factors. Medical institutions should attach importance to the core competency building of medical personnel and advocate for patient participation in safety culture construction; Promote the development of safety culture in medical institutions and improve the management system for adverse events; Improve team collaboration efficiency, standardize communication and exchange modes, and improve the quality of medical safety.

Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .

Objective To explore the safety and efficacy of intrathecal administration of adipose stem cells de-rived from bioactive secretome (ASCBS)in treatment of whiter matter injury (WMI)in the preterm infants. Methods Sixty - three cases of WMI were recruited according to the uniform standards from multiple medical centers and they were divided into 3 gestational age (GA)subgroups,which were 21 cases in group A (GA 24 - 28 + 6 ),20 cases in group B (GA 29 - 32 + 6 ),and 22 cases in group C (GA 33 - 36 + 6 ). The patients were randomly divided into treatment groups and control groups by tossing coins. The treatment groups received lumbar puncture followed with ASCBS intra-thecal injection once daily for 3 consecutive days. Follow - up study included Neonatal Behavioral Neurological Assess-ment (NBNA)at term - equivalent age and neurodevelopment at corrected age of 6 - month. Neurodevelopment was assessed by using the Bayley Scales of Infant Development and Peabody Developmental Motor Scale. The survival rates, NBNA scores,mental development index (MDI),psychomotor develop index (PDI),total motor development quotient, gross motor development quotient and fine motor development among each subgroup were compared. Results Sixty -three cases were recruited,including 31 in the treatment group and 32 in the control group. Only 1 case in the treatment groups lost in the follow - up. No clinical side effects were found in the treatment groups. There was no significant diffe-rence in the survival rate and complication in the preterms in all subgroups of the treatment group and control group (all P > 0. 05). The gross and total motor development quotient in the treatment group A was higher than that in the control group A(gross motor development quotient:98. 330 ± 6. 282 in treatment group A,90. 330 ± 3. 777 in control group A, P = 0. 040;total motor development quotient:97. 330 ± 4. 803 in treatment group A,91. 000 ± 4. 472 in control group A,P = 0. 023). The rest findings showed no significant difference between groups. Conclusion The treatment of WMI in preterm infants with ASCBS is safe and can promote the motor development of preterm infants with GA in 24 - 28 weeks.

Objective:To investigate the clinical efficacy of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with preservation of the first branch of the right gastroepiploic vein in early gastric cancer (EGC).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 38 EGC patients who were admitted to the Subei Hospital Affiliated to Yangzhou University from July 2018 to May 2021 were collected. There were 18 males and 20 females, aged 60 (range, 39?73) years. All patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein.Observation indicators: (1) surgical and postoperative condi-tions; (2) postoperative histopathological examination. (3) follow-up. Follow-up was conducted using outpatient examination, WeChat interview and medical record review to detect the nutritional status, residual stomach function, cholecystolithiasis, tumor recurrence and metastasis and death of patients. Follow-up was up to July 2022. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions. All 38 patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative first liquid food intake and duration of postoperative hospital stay of the 38 patients were (180±28)minutes, (58±38)mL, (2.7±0.6)days, (3.4±0.7)days and (10.3±2.8)days, respectively. Of the 38 patients, there were 6 cases with postoperative complications ≥grade Ⅱ of Clavien-Dindo classification. (2) Postoperative histopatho-logical examination. The tumor diameter, distance from proximal resection margin to tumor and distance from distal resection margin to tumor of the 38 patients were (1.8±0.5)cm, (3.4±0.2)cm and (4.3±0.4)cm, respectively. Both of proximal and distal resection margin was negative. Numbers of lymph node examined and numbers of lymph node examined in the No.6 lymph node of the 38 patients were 23.3±3.9 and 3.4±1.1, respectively. There were 38 cases with pathological T1 stage including 23 cases of T1a stage and 15 cases of T1b stage. There were 36 cases with pathological N0 stage and 2 cases with pathological N1 stage. There were 36 cases with pathological ⅠA stage and 2 cases with pathological ⅠB stage of TNM staging. (3) Follow-up. All 38 patients were followed up for 18(range, 12?48)months. The hemoglobin, serum albumin and total serum protein of the 38 patients were (125.4±5.8)g/L, (42.4±2.3)g/L and (71.6±2.1)g/L, respectively, at postoperative 6 month. Endo-scopy was used to evaluate the function of residual stomach of patients at postoperative 12 month. There were 4 patients with moderate amount of food remaining in the residual stomach. No patient suffered reflux esophagitis, reflux gastritis and bile reflux. None of the 38 patients received post-operative chemotherapy, and there was no tumor recurrence and metastasis or death occured in patient.Conclusion:TLPPG with preservation of the first branch of the right gastroepiploic vein is safe and feasible for the treatment of EGC patients with tumor located at 1/3 of the middle segment of stomach.

Objective To evaluate the clinical efficacy,safety and the postoperative functional improvement of the surgical treatment for postpartum diastasis recti(PDR).Methods A retrospective study was conducted on the patients with PDR who underwent surgical treatment in Department of Hernia and Abdominal Wall Surgery,Shanghai East Hospital,Tongji University from November 2018 to October 2023.The patients'demography,operation data,postoperative complications,recurrence and functional evaluation before and after surgery were analyzed.Results A total of 39 cases were included.Open surgery was performed in 21 cases,laparoscopic surgery in 17 cases,and hybrid surgery in 1 case.On the basis of linear alba reconstruction(LAR),26 cases were additionally repaired with Sublay mesh,9 with Onlay,and 1 with intraperitoneal onlay mesh(IPOM);the other 3 cases were only performed with LAR.The follow-up ranged 6-45 months,and the completion rate was 92.3%.During the follow-up,no recurrence was observed,and the overall complication rate was 20.5%,including 1 case with delayed wound healing,2 cases with seroma,and 5 cases with skin disorders in paraumbilical and subumbilical area.There were significant changes of European Registry for abdominal wall hernias quality of life(EuraHS QoL)score and Oswestry disability index(ODI)after operation,indicating significant improvement in QoL and lower back pain.The inter-recti distance(IRD)of the patients undergoing laparoscopic surgery was less than that of the patients undergoing open surgery(median 4.0 cm vs.4.5 cm),and the duration of hospital stay of the patients undergoing laparoscopic surgery was shorter than that of open surgery(median 7 days vs.9 days).Conclusions In general,the surgical treatment of PDR is safe and effective,and it can not only correct the separation,but also improve QoL and lower back pain of the patients.Tailored surgical procedures should be selected for patients with different conditions.