[Objective]To discuss the clinical results and treatments of the Monteggia's fracture in children.[Method]Total of 66 patients including 61 fresh and 5 old fractures were reviewed.There were 47 males and 19 females.According to the Bado classification system: 46 of type Ⅰ,4 of type Ⅱ,15 of type Ⅲ,1 of type Ⅳ,all patients received conservative or operatire treatment.The conservatively treated patients received manipulation and plaster immobilization.In the operative group,the patients were fixed with single or/and double Kirschner's wires after reduction of the radiohumeral joints or/and fractured ulna.Neither reparation nor reconstruction was needed.[Result]All patients were available at the final follow up with 0.5～5 years.According to the Li Hanmin's scoring system for the motion function in children: excellent and good rate was 95.7% in conservative group and 84.2% in operative group.There was no complication such as myositis ossificans,synostosis of radius and ulna,ulna nonunion,radial head dislocation and profundus radial nerve injury.The cases of nerve injury were complete recovered after operation two or four months later.[Conclusion]The clinical results of the Monteggia's fracture in children was very good with immediate reduction and internal fixation in proper cases,a good overall therapeutic outcome can be expected in children with Monteggia's fracture.It is very important to prevent missed diagnosis.

Objective To explore the effects of delayed mild hypothermia (MHT) in different time windows on the expressions of Bcl-2, Bax and Caspase-3 in brain tissue of model rats with traumatic brain injury (TBI). Methods Thirty-six clean adult male SD rats were randomly divided into NT group (normal temperature), MHT 15 min group, MHT 2 h group and MHT 4 h group. TBI rat model was established by electronical controlled cortical injury device. The rats in the NT group were treated with normothermia (37℃) and the rats in the three hypothermia groups were implemented with low temperature (33.0±1.0)℃at 15 min, 2 h and 4 h for 6 h respectively after establishment of TBI model. The modified neurological senerity scores (mNSS), morphological changes in hippocampal CA1 areas, immunohistochemical staining and Western blot assay for Bcl-2, Bax and Caspase-3 were compared 3 days after TBI between the four groups. Results The neurological behavioral deficits were found in each group. Compared with the NT group, the mNSS were decreased in the three hypothermia groups (P<0.01). The results of HE staining showed that the structure of neurons was regular and arranged neatly, and the number of neurons decreased with alleviated nuclear fragmentation and dissolution in hypothermia groups. Compared with the NT group, the expression of Bcl-2 was upregulated, and the expressions of Bax and Caspase-3 were downregulated in three hypothermia groups (P<0.05). The above experimental results were superior in MHT15 min group to MHT 2 h group, and the therapeutic effect in MHT 2 h group was similar to MHT 4 h group. Conclusion The proper delayed mild hypothermia treatment could inhibit neuronal apoptosis and alleviate brain damage.

Objective To investigate whether mild hypothermia can promote neurogenesis in the dentate gyrus of hippocampus and cognitive function recovery after traumatic brain injury ( TBI) through inhibiting apoptosis of hippocampal neurons. Methods A total of 66 healthy adult Sprague-Dawley rats were randomly divided into sham group, TBI group and TBI+hypothermia group, with 22 rats in each group. The rat TBI model was established using the fluid percussion device. The rats in TBI +hypothermia group received 4-hour hypothermia therapy immediately after injury, with the target temperature of 33. 5℃. Bromodeoxyuridine (BrdU) was injected into the rats' abdominal cavity to label the mitotic cells. The test of Morris water maze was used to evaluate the rats' spatial learning and memory capabilities. Immunofluorescence staining was used to observe the expression levels of BrdU, doublecortin (DCX), neuron specific nuclear protein (NeuN), cysteinyl aspartate specific proteinase 3 (caspase-3) and cleaved caspase-3 expressions in dentate gyrus of hippocampus at 7 days and 28 days after injury. Expressions apoptosis-related proteins including the factor associated suicide ( FAS )/factor associated suicide ligand (FASL), B-cell lymphoma-2 (Bcl-2), caspase-3 and cleaved caspase-3 expressions were detected by Western blot assay. Results The water maze tests at 28 days after injury showed that compared with TBI group, the escape latency in TBI+hypothermia group was significantly shorter [(24. 2 ± 5. 9)s:(18 ± 4. 1)s], and both the time in the target quadrant and the number of platform crossing were increasedsignificantly[(24.9±6.5)s:(31.7±5.2)s; (1.9±0.8) times:(3.5±1.2)times](P<0. 05). Compared with the sham group, in TBI group and TBI+hypothermia group, the BrdU+ new-born cells in the dentate gyrus of hippocampus were significantly increased at 7 days after injury [(9. 4 ± 4. 1):(33. 4 ± 3. 8);(9. 4 ± 4. 1):(45. 8 ± 5. 6)], the BrdU+ /DCX+ new-born neurons were increased at 7 days after injury [(2. 0 ± 0. 6):(9. 6 ± 1. 6);(2. 0 ± 0. 6):(19. 2 ± 3. 7)], and the BrdU+ /NeuN+mature neurons were increased at 28 days after injury [(2. 6 ± 1. 0) :(17. 2 ± 3. 9); (2. 6 ± 1. 0) :(33. 6 ± 9. 1)] (P<0. 01). TBI group showed more obvious increase than the TBI+hypothermia group (P<0. 01). Moreover, compared with 7 days after injury, the number of BrdU+ cells at 28 days after injury was further increased in TBI +hypothermia group but decreased in TBI group [(45. 8 ± 5. 6) :(58. 8 ± 9. 2);(33. 4 ± 3. 8):(22. 0 ± 3. 5)](P<0. 05 or <0. 01). Compared with the sham group, the caspase-3 +NeuN+ and caspase-3 +NeuN+ apoptotic neurons were significantly increased at 7 days after injury in TBI group [(2. 0 ± 0. 9):(11. 6 ± 2. 6); (2. 6 ± 1. 0):(10. 2 ± 2. 9)] (P<0. 05). Compared with the TBI group, the cleaved caspase-3 +NeuN+ apoptotic neurons were decreased in TBI+hypothermia group [(6. 6 ± 2. 0):(11. 6 ± 2. 6)](P<0. 05). Furthermore, compared with the TBI group, mild hypothermia might down-regulate the expression of FAS, FASL, cleaved caspase-3 and caspase-3 and up-regulate the expression of Bcl-2 in the hippocampus [(1. 54 ± 0. 15) :(1. 14 ± 0. 12);(1. 06 ± 0. 04):(0. 80 ± 0. 09); (0. 84 ± 0. 03):(0. 62 ± 0. 08); (0. 93 ± 0. 06):(0. 86 ± 0. 09);(0. 71 ± 0. 01):(1. 58 ± 0. 18)](P<0. 05). Conclusions Mild hypothermia might inhibit apoptosis of hippocampal neurons through cleaved caspase-3, FAS/FASL and Bcl-2 pathways, thus improving the neurogenesis and maturation of neurons in the dentate gyrus of hippocampus and facilitating cognitive function recovery in rats. It indicates that the function of hypothermia in anti-apoptosis and neurogenesis and maturity of hippocampal neurons may have a potential role in predicting the prognosis of TBI patients.

Objective:To investigate the effect of Da Vinci robot-assisted single-port plus-one laparoscopic pyeloplasty (RSPY) in children with ureteropelvic junction obstruction (UPJO).Methods:The clinical data of 13 children with UPJO diagnosed by robot-assisted single-port plus-one laparoscopic pyeloplasty in Fujian Provincial Hospital from September 2021 to August 2022 were retrospectively analyzed. The mean age of the children was 60.0 (1.3, 108.0) months. The lesions of 10 patients were on the left, and 3 were on the right. The clinical manifestations were abdominal pain in 3 cases, urinary tract infection in 2 cases, and no symptoms in 10 cases. Preoperative isotope renogram showed affected renal function (28.32±1.82)%, and bilateral renal function difference > 10% in 7 cases. Mechanical obstruction existed in 5 cases. Preoperative ultrasound showed the affected side's renal cortex thickness of (1.98 ± 0.23) cm. During the operation, a single-port multi-channel trocar was placed in the umbilicus with another single port in the epigastrium, and a robotic system was placed to explore the subperitoneal dilated renal pelvis. The renal pelvis was suspended and pulled through the abdominal wall. The visual field was exposed, and the dilated renal pelvis was incised. The dilated renal pelvis was cut, a ureteral stent was placed, and the ureteropelvic duct was anastomosed.Results:The operation of 13 cases was successfully completed, without conversion to open surgery. The operation time was 180.0(165.0, 190.2)min. The intraoperative blood loss was < 5 ml. The postoperative hospital stay was 7.0(7.0, 7.0)d, and hospitalization costs were 56.3(52.1, 56.5)thousand yuan. The ureteral stent was removed 2 months after the operation, and no obvious complications such as urinary tract infection or low back pain occurred. The median postoperative follow-up was 12 months, ranged from 6 to 18 months. Urinary color ultrasound showed that the renal cortex was (4.95±0.57) cm, which was thicker than before. Isotope renogram showed that the renal function was (38.02±1.76)%, which was higher than before. Mechanical obstruction was transformed into incomplete obstruction.Conclusions:Da Vinci robot-assisted single-port plus-one laparoscopic pyeloplasty is precise and could achieve good surgical results on the basis of the effective restoration of lesion kidney function.

To observe the effect of indomethacin suppository 100 mg before endoscopic retrograde cholangiopancreatography (ERCP) on the level of platelet microparticles (PMPs) in patients with post-ERCP pancreatitis (PEP). A total of 191 patients receiving ERCP were collected from June 2019 to October 2020 in the First Affiliated Hospital of Anhui Medical University and were randomly divided into the indometacin group ( n=96) and the control group ( n=95) by random number table method. The indometacin group received 100 mg indometacin suppositories before ERCP and the control group received placebo of equal quality. Levels of PMPs before operation, 3 hours and 24 hours after operation were measured by flow cytometry. The levels of IL-1, IL-6 and TNF-α in the plasma before ERCP, 3 hours and 24 hours after ERCP were also detected. The incidence of PEP in the indometacin group was 5.21% (5/96), which was significantly lower than that in the control group [13.68% (13/95), P=0.044]. The preoperative PMPs level in the indometacin group (1 910.01/μL) was slightly lower than that in the control group (2 351.87/μL) with no significant difference ( P>0.05). The PMPs levels in the indometacin group 3 hours and 24 hours after ERCP (1 671.47 /μL, 862.74/μL) were significantly lower than those of the control group (2 443.75/μL, 2 536.76/μL, both P<0.05). Inflammatory cytokines including IL-1, IL-6 and TNF-α showed the same tendency. Indometacin can reduce the incidence of PEP, for the reason that indometacin may decrease the levels of PMPs.

Objective:To investigate the safety and effectiveness of robot-assisted total knee arthroplasty (TKA).Methods:From August 2021 to March 2022, the data of 69 patients who received robot-assisted TKA for inflammatory disease of knee in 6 hospitals were collected, including 24 males and 45 females, aged 52±6 years (range, 46-72 years), including 53 cases of knee osteoarthritis,10 cases of rheumatoid arthritis, and 6 cases of traumatic arthritis. Imaging data examination of patients was completed according to the multicenter specification. Preoperatively, the patient's CT data were extracted before surgery and a personalized prosthesis positioning plan was designed by the robotic system to determine the prosthesis size, lower limb force lines, and femoral and tibial osteotomy volumes; intraoperatively, the osteotomy template was robotically controlled to complete the osteotomy according to the prosthesis positioning plan, and the intraoperative osteotomy volumes were measured to verify the accuracy of the robot-assisted TKA osteotomy with the preoperative planning. Postoperatively, the lateral angle of the distal femur, the medial angle of the proximal tibia and the hip-knee-ankle angle were measured in the coronal plane according to radiographs; the postoperative outcome was evaluated 3 months after operation, using the American Knee Society score (KSS), including the KSS knee score and functional score.Results:The operative time was 97.3±2.3 min (range, 80-110 min) and the amount of bleeding was 320.0±6.2 ml (range, 300-350 ml) in 69 patients. Three months after operation, the mean range of motion of knee joint was increased from 82.2°±1.1° before surgery to 119.7°±0.8° after surgery ( t=27.65, P<0.001), and the line of force of lower limb was improved from 160.9°±0.5° before surgery to 178.0°±0.2° after surgery ( t=32.03, P<0.001). KSS-knee score increased from 54.8±0.7 points before operation to 85.0±0.5 points after operation, and KSS-functional score increased from 56.5±0.7 points before operation to 85.9±0.4 points after operation, the difference was statistically significant ( t=35.45, 36.58, P<0.001). The proportion of patients with intraoperative femoral and tibial osteotomies within 2 mm osteotomy error compared with preoperative planning was 97% for the lateral tibial plateau, 100% for the medial tibial plateau, 100% for the lateral distal femur, 99% for the medial distal femur, 93% for the lateral posterior femoral condyle, and 100% for the medial posterior femoral condyle; The proportion of patients with postoperative anteroposterior X-ray measurement angle error within 3° was: 100.0% for the distal lateral femoral angle, 100.0% for the proximal medial tibial angle, and 100% for the hip-knee-ankle angle. No complications occurred in all patients except for one case in which fat liquefaction occurred in the postoperative wound. Conclusion:Robot-assisted TKA is a safe and effective surgical method for the treatment of inflammatory disease of knee with accurate prosthesis installation and good postoperative recovery of lower limb alignment.

Objective To investigate the effects of high-definition transcranial direct current stimulation(HD-tDCS)on the modulation of the H-reflex and M-wave during ankle dorsiflexion-plantar flexion fatigue tasks to provide direction for the application of HD-tDCS in mitigating neuromuscular fatigue.Methods Twenty healthy young male participants were recruited and randomly assigned to either the real stimulation or sham stimulation group,with 10 participants in each group.The intervention consisted of a 5-day single-blind HD-tDCS application(duration:20 min;intensity:2 mA;target:Cz).Baseline measurements of the H-reflex and M-wave under resting conditions,M-wave during maximal voluntary isometric contraction(MVIC)of the dorsiflexor muscle,and MVIC torque of the dorsiflexor and plantar flexor muscles were obtained.An ankle dorsiflexion fatigue task was performed to determine the time to achieve fatigue for the task.The same fatigue task was repeated and evaluated one day after the intervention.A repeated-measures two-factor(stimulation condition x pre/post fatigue)analysis of variance(ANOVA)was used to analyze the effects of independent variables on the mechanical properties of the muscles and α-motoneuron conduction characteristics.Results After fatigue,voluntary activation(VA),maximal H-reflex(Hmax),maximal M-wave(Mmax),and dorsiflexor and plantar flexor MVIC torques in both groups were significantly reduced compared with pre-fatigue levels(P＜0.05).However,compared to the real stimulation group,the sham stimulation group showed a more significant decline in VA and plantar flexor MVIC torque(P＜0.05).Conclusions A continuous 5-day HD-tDCS intervention can effectively increase α-motoneuron activity at the spinal segment.It can also exert an inhibitory effect on reducing information transmission capacity at the peripheral neuromuscular junction under the ankle dorsi-plantarflexion fatigue task.

Objective : To analyze the clinical characteristics of patients with abdominal type allergic purpura(HSP), to improve their diagnostic level, and to explore the risk factors for gastrointestinal bleeding in HSP patients. Methods : A retrospective analysis was conducted on the clinical manifestations, laboratory data, imaging, endoscopic, and pathological characteristics of 98 patients with abdominal type HSP. Based on the occurrence of gastrointestinal bleeding, 98 patients were divided into a bleeding group and a non-bleeding group, and the risk factors for gastrointestinal bleeding in HSP patients were analyzed. Results : Abdominal HSP often presented with abdominal pain, vomiting, vomiting blood, black stools, and bloody stools. Imaging often showed edema and thickening of the duodenum and jejunum, as well as enlargement of surrounding lymph nodes. Under endoscopy, the descending part of the duodenum and jejunum mucosa were commonly congested and edematous with erosion, and ulcers were seen in the distal ileum. Pathology commonly involved acute and chronic inflammation of the mucosa with congestion, edema, and local erosion. Patients with gastrointestinal bleeding had significantly higher levels of white blood cell count(WBC), neutrophil count(NEUT), C-reactive protein(CRP), D-dimer(D-D), and fibrinolytic products(FDP) compared to non-bleeding patients(P<0.05), while levels of red blood cell count(RBC), hemoglobin(HGB), and albumin(ALB) were significantly lower than those of non bleeding patients(P<0.05). Logistic regression analysis showed that decreased ALB and increased FDP were independent risk factors for gastrointestinal bleeding in patients with abdominal HSP(P<0.05). The areas under the ROC curves of ALB and FDP were(AUC=0.877, 95%CI:0.794-0.960,P<0.01) and(AUC=0.806, 95%CI:0.722-0.890,P<0.01), respectively. The maximum value of the Jordan index for ALB was 0.734, with sensitivity and specificity of 89.6% and 83.9%, respectively, and had a critical value of 38.2 g/L. The maximum value of the Jordan index for FDP was 0.577, with sensitivity and specificity of 64.2% and 93.5%, respectively, and had a critical value of 18.14 μg/ml. There was no statistically significant difference in the ROC curves between ALB and FDP. Conclusion For HSP with abdominal pain as the initial symptom, imaging and endoscopic examination are helpful for early diagnosis. Decreased ALB and elevated FDP are independent risk factors for gastrointestinal bleeding in adult patients with abdominal HSP.

ObjectiveTo make statistics on the biological characteristics， medicinal parts， chemical components， and other aspects of thorny medicinal plants and systematically analyze the correlations between their natures， tastes， and meridian tropism， so as to provide a theoretical basis for the clinical application and resource development of these plants. MethodThe Chinese Pharmacopoeia （2020 edition） and the processing standards of various provinces and cities and other related documents were reviewed， on the basis of which 46 species of thorny medicinal plants were selected. The natures， tastes， meridian tropism， medicinal parts， chemical components， pharmacological activities， and geographical distribution of these plants were summarized and analyzed in Excel 2013 and SPSS Statistics 26.0. ResultThe 46 species of thorny medicinal plants belonged to 25 families， 1 class， 1 phylum of 1 kingdom. In terms of the location of thorns， the frequency of these medicinal plants followed the trend of leaf thorns>peel thorns>branch thorns>fruit thorns. In terms of the nature， taste， and meridian tropism， the frequency of these plants was in the orders of warm>plain>cold>cool>hot， bitter>sweet>pungent>sour>salty， and liver>lung>spleen=large intestine>heart>kidney， respectively. In terms of the medicinal parts， the frequency followed the trend of roots and rhizomes>fruits>whole plants>flowers>leaves. The thorny medicinal plants were mainly distributed in north and southwest China. The thorny medicinal plants mainly contained flavonoids， alkaloids， and saponins and had the effects of clearing heat and detoxifying， resolving stasis and eliminating carbuncle， moving Qi and relieving pain， and alleviating edema and expelling pus. Moreover， 24 of them had anti-tumor activity. ConclusionMost of the thorny medicinal plants belong to Compositae， Leguminosae， and Rosaceae， have leaf thorns， a warm nature， a bitter taste， tropism to the liver meridian， and roots as the medicinal part. These plants are mainly distributed in north China， with the effects of clearing heat and detoxifying， resolving stasis and eliminating carbuncle. In summary， the thorn location， distribution， and medicinal parts of thorny medicinal plants are correlated with the natures， tastes， and meridian tropism. The findings provide clues for the development and utilization of these plants.

Neurosurgery navigation system, which is expensive and complicated to operate, has a low penetration rate, and is only found in some large medical institutions. In order to meet the needs of other small and medium-sized medical institutions for neurosurgical navigation systems, the scalp localization system of neurosurgery based on augmented reality (AR) theory was developed. AR technology is used to fuse virtual world images with real images. The system integrates computed tomography (CT) or magnetic resonance imaging (MRI) with the patient's head in real life to achieve the scalp positioning. This article focuses on the key points of Digital Imaging and Communications in Medicine (DICOM) standard, three-dimensional (3D) reconstruction, and AR image layer fusion in medical image visualization. This research shows that the system is suitable for a variety of mobile phones, can achieve two-dimensional (2D) image display, 3D rendering and clinical scalp positioning application, which has a certain significance for the auxiliary neurosurgical head surface positioning.
Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Neurosurgery ; methods ; Scalp ; Tomography, X-Ray Computed