BACKGROUND:The three-dimensional structure of acupoint anatomy was integrated into the teaching of acupuncture manipulation. Combined with the implementation and application of the acupuncture and moxibustion in digital virtual human, it can greatly improve the teaching effect and learning interest. OBJECTIVE:To investigate the acupuncture virtual human with integration of virtual reality force feedback technology and tissue deformation. METHODS:Using virtual reality technology, with computer as the core, we generated a specific range of virtual environment with realistic visual, auditory and tactile integration, col ected clinical expert acupuncture technique, matched the sensing equipment that can reflect the intensity, displacement and speed sensing of acupuncture. Based on image segmentation of virtual human, we constructed human tissue mechanics model, built virtual acupuncture-force-feedback system, and faithful y transmitted to the operator by a force feedback device. On one hand, based on VOXEL-MAN virtual human development platform, we finished the three-dimensional browser redevelopment of the science of acupuncture and moxibustion of Shu acupoint, which provided visual perception for people. On the other hand, based on modern biomechanics theory, we established models by graphics and image processing technology and force feedback technology. The stress process of the structure of each layer in the acupuncture point area was given to people in a sense of touch by the manner of virtual reality and force feedback. RESULTS AND CONCLUSION:With the man-machine interactive operation platform of virtual acupuncture force feedback system, operator could see the dynamic process of acupuncture needle into human body, and could feel the real counterforce in the control terminal of force feedback instrument. By operating acupuncture needle in virtual environment of force feedback instrument, acupuncture was performed in virtual human. The system meets the two requirements:the feedback changes produced by tissue interaction were similar to real acupuncture feedback force data measured by instrument. The acupuncture needle entered into different tissues, a sense of power changed significantly;there was progressive feeling with different layers, reaching a realistic experience. During the whole training, the image was smooth;virtual needle was responsive, which better meets the requirements of virtual reality.

Objective To analyze the CT imaging features of Castleman disease and enhance our knowledge of Castleman disease.Methods Twenty two patients with lymph node biopsy-proved or surgeryproved Castleman disease were retrospectively reviewed in this study.Of the 22 patients,18 had localized lesion and 4 patients had multicentric lesions.Correlation was made between CT and pathologic findings.Results Eighteen patients with localized Castleman disease had the hyaline-vascular type and showed well-circumscribed masses with soft-tissue density [mean CT value,(45 ± 16) HU],punctate or bifurcate calcification and linear low-density areas on non-enhanced CT images.All localized masses showed significant enhancementwith an increase of(56 ± 22)HU on arterial phase and showed residual enhancement and some low-density areas on delayed phase.Enhancing patterns were variable,including homogeneous enhancement,gradual enhancement from the edge to the center of mass and heterogeneous enhancement.Four patients with localized lesion demonstrated enhancing vessels around masses.Four patients with muhicentric CD belonged to the plasma cell type and had multiple enlarged lymph nodes.Plasma cell type masses with homogeneous density also showed enhancement after injection of contrast media but appeared to reveal a less increase of (32 ± 10) HU than the hyaline vascular type.Conclusions The localized Castleman disease showed certain characteristics on CT imaging includingcalcification and contrast enhancing patterns,which could help in the differential diagnosis of this disease.The muhicentric Castleman disease did not reveal any useful imaging features.

BACKGROUND:The correct and effective acupuncture manipulation of famous doctors are used to generate the realistic visual, auditory and tactile integrated computer virtual environments for acupuncture simulation based on the various techniques with the core of computer, which can greatly enhance the realism of the operator, and reduce the clinical acupuncture accidents. OBJECTIVE:To establish the virtual Shenshu acupuncture force feedback simulation system. METHODS:Based on the force feedback device, the Shenyu manipulations from the famous acupuncturists were col ected and integrated into the digital virtual body. On the three-dimensional digital human body integrated with information of Shenshu, the interaction force of needle body and tissues during the acupuncture process was analyzed with the virtual reality technology according to physical characteristics of the tissues within Shenshu, in order to establish the mechanical model to simulate needle body force, and to transmit truly to the operator by the force feedback device. RESUTLS AND CONCLUSION:Shenshu virtual acupuncture force feedback simulation was preliminary established, and the sense of touch could be reproduced lively during mimic the acupuncture of Shenshu on the visualized virtual acupuncture human. Shenyu acupuncture force feedback researches have provided a preliminary exploration for virtual acupuncture that integrated with the information of visual, tactile and force feedback, and also provided a dynamic one-on-one simulation means for acupuncture teaching.

Diarrhea is a frequent complication after kidney transplantation, which is a common clinical manifestation of prevalent diseases following multiple types of organ transplantation. The common causes of diarrhea after kidney transplantation include adverse reactions of immunosuppressants, infectious diseases and de novo postoperative inflammatory bowel disease, etc. Diarrhea could seriously affect the quality of life of kidney transplant recipients, and may lead to allograft dysfunction or even death of recipients. Because the causes of diarrhea after kidney transplantation are complicated and probably overlap with each other, along with individual differences among recipients, the etiological diagnosis and targeted treatment of diarrhea after kidney transplantation should follow the principles of gradual and phased treatment. In this article, the epidemiology and harm, common causes and management strategies of diarrhea after kidney transplantation were summarized, aiming to deepen the clinicians' understanding and enhance the diagnosis and treatment levels of diarrhea after kidney transplantation, thereby improving the quality of life and prognosis of kidney transplant recipients.

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.

To explore the relationship between sleep duration and brachial-ankle pulse wave velocity(baPWV) in patients with type 2 diabetes mellitus(T2DM). A total of 1 755 patients with T2DM received standardized management of metabolic disease from March 1, 2018 to February 29, 2020 were included. All patients were classified into three groups according to the sleep duration: short(≤6 h), medium(>6 h to 8 h) and long(>8 h). Increased arterial stiffness was defined as baPWV≥1 600 cm/s. The prevalence of baPWV≥1 600 cm/s was 39.7%, 30.8% and 38.6% in short, medium and long sleep duration group, respectively( P<0.01). Multivariate logistic regression analysis showed that patients with long sleep duration( OR=1.317, P<0.05) but not short sleep duration( OR=1.169, P>0.05) had a higher risk for baPWV≥1 600 cm/s compared with the reference group with medium sleep duration. Stratified analyses by sex showed that the OR were 1.735( P<0.05) among female and 1.131( P>0.05) among male respectively for baPWV≥1 600 cm/s in long sleep duration group when compared with medium sleep duration group. Sleep duration>8 h was found to be associated with elevated baPWV in patients with T2DM. There were gender differences in the correlation between long sleep duration and baPWV.

Objective To investigate the feasibility of 3-D printing technology in the application of proxi-mal tibial epiphyseal injury fracture surgery for teenagers. Methods Clinical materials of the 8 patients with proxi-mal tibial epiphyseal injury fracture who were admitted to our hospital from January 2014 to March 2016 were retro-spectively analyzed. CT data of all patients was collected before the surgery and was used for fracture 3-D recon-struction with Minics software to print out the 1:1 physical model. Meanwhile,surgical simulation was carried out on the 3-D model to design the internal fixation scheme,and all intraoperative operations were implemented in line with the preoperative planning. Postoperative brace immobilization and the early-stage function exercise were taken and growth situation of the affected limbs and fracture healing were observed and recorded. In line with the modified Hohl and Luck knee score standards,knee functional score was taken 12 months after the surgery. Results All pa-tients received postoperative follow-up service for 12 to 18 months,with the average of 15.3 months. All patients were bony union,with the excellent knee score rate of 100%. The full-length axis of two limbs was compared be-tween the postoperative reexamination and no premature skeleton closure. Pronation and supination of the knee,un-stable joints and other complications were investigated. No obvious differences were found among the activity of the affected limbs and 12-month growth length after the surgery and that of the uninjured side. Conclusions 3-D printing technology is a strong clinical guidance to the treatment of proximal tibial epiphyseal injury fracture surgery for teenagers.

Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.

Dopamine is the precursor of biosynthesis of norepinephrine.Low-dose dopamine mainly excites dopamine receptors,which may dilate renal and mesenteric vessels,increase renal blood flow and improve the microcirculation.In recent years,low-dose dopamine has been widely applied in the field of kidney transplantation due to its vasoactive effect.However,with the development of evidence-based medicine,the role of dopamine in protecting the perfusion function of renal allograft in kidney transplantation has been questioned.Multiple studies have shown that dopamine brings no significant benefit to renal and cardiac function in kidney transplantation,exerts low pressor effect,and may even increase the risk of perioperative complications.Norepinephrine may be used as a safe substitute.In this article,recent progress in the effect of dopamine upon renal and cardiac function and hemodynamics during kidney transplantation was reviewed,aiming to provide reference for clinical application of dopamine in kidney transplantation.

Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.