[Objective]To explore the efficacy and results of tibial tubercle osteotomy used in exposure in complicated total knee arthroplasty.[Methods]During the period from Apr.2005 to Apr.2007,the tibial tubercle osteotomy were used in 16 cases of complicated total knee arthroplasty.The mean follow-up time were 20 months(6～26 months).Knee society score(KSS) and radiography were used to evaluate the clinical results.[Results]The mean KSS improved from 46 points preoperatively to 91 points postoperatively.The mean ROM improved to from 53?preoperatively 105?postoperatively.At 3 months after surgery the radiography examines showed all 16 cases had achieved satisfactory healing.The tubercle fragment slided toward proximal 0.7 cm occurred in one case,and finally healed at that position.[Conclusion]Exposure of the knee may be difficult in the total knee arthroplasty,but tibial tubercle osteotomy is a safe and reliable procedure which affords excellent exposure.

Objective:To analyze and evaluate the teaching effect of the Problem-Based Learning and intelligent simulation training in emergency medicine.Methods:Based on Problem-Based Learning,129 residents of our hospital accepted the cardiopulmonary resuscitation training and test by intelligent simulation training.And their feedback questionnaires were analyzed.Results:After training,their abilities to deal with the cardiac arrest have made a great progress(P

Objective: To observe the dynamic changes of plasma level thymosinβ4 (Tβ4) in acute myocardial infarction (AMI) patients with intervening therapy within 15 days of onset and to explore the relationship between Tβ4 and clinical prognosis in AMI patients.
Methods: Our research included 2 groups:AMI group, n=69 and Control group, the patients with suspected chest pain while CAG excluded coronary artery stenosis, n=32. Plasma levels of Tβ4 were examined in all AMI patients on admission day and every day until 15 days of onset;AMI patients were followed-up for 18 months and the endpoint was defined as major adverse cardiovascular event (MACE) occurrence.
Results: ①Compared with Control group, AMI group had increased plasma level of Tβ4 on admission day and on day-15 of onset, P<0.01. ② With intervening therapy, AMI group had elevated Tβ4 level upon immediate onset, it was decreased on day-1, reached low level on day-3 and elevated to peak on day-6, then reduced followed by slightly raising on day-11.③During follow-up period, the AMI patients without MACE had the higher mean in-hospital maximum Tβ4 value than those with MACE occurrence, P<0.01. Logistic regression analysis indicated that the mean in-hospital maximum Tβ4 value was related to MACE occurrence during follow-up period (OR=0.999, 95%CI 0.999-1.000).
Conclusion: AMI may induce up-regulated expression of plasma Tβ4;with intervening therapy, Tβ4 showed a trend of“elevation-reduction-elevation-reduction”at the early stage of AMI. High expression of Tβ4 was helpful for improving clinical prognosis in AMI patients which may provide a theoretical basis for exogenous use of Tβ4 in AMI treatment.

Objective:To observe the effects of static 70° head-up tilted standing and of repeated body repositioning on hemodynamics in healthy young and middle-aged persons.Methods:The hemodynamics of 24 middle-aged and 23 younger persons were studied. Both groups were requested to perform static 70° head-up tilted standing and to repeatedly change their body position from 0° to 70° of tilt at a velocity of 1°/second for ten minutes in a random order. Before, between and after each test the subjects rested supine for ten minutes. Hemodynamic variables and blood pressure were recorded non-invasively.Results:The average heart rate (HR) increased significantly in both groups when rising from supine to the testing positions. In 70° tilted standing the average HR of the youth group, 84.0±9.5bpm, was significantly higher than that in the other position and that of the middle-aged group in the same position. The average HR of the middle-aged group in 70° tilted standing was also significantly higher than in the other position. Among the middle-aged group, the average stroke volume (SV) in the testing positions was significantly lower than when resting. Significant differences were observed in the average diastolic blood pressure (DBP) between the testing and rest positions for both groups, with the average DBP of the middle-aged group significantly higher than that of the youth group in all three positions. Among the youth group, the average SV, CO and systolic blood pressure (SBP) of the males were significantly higher than among the females in all of the different body positions.Conclusions:Young persons mainly rely on an increased heart rate to maintain cardiac output while middle-aged participants appear to achieve this through increased peripheral resistance. Repeated position changes have less impact on hemodynamics than 70° inclined standing, making it a safer and more stable training method. However, the long-term effects of such intervention need to be confirmed in further studies.

Objective To observe the therapeutic effect of consciousness-restoring needling combined with comprehensive rehabilitation training on motor function and the activities of daily living of poststroke patients with hemiplegia. Methods Sixty qualified patients were evenly randomized into observation group and control group. All of the patients were given conventional medicine treatment and conventional rehabilitation training, and the treatment group was given consciousness-restoring needling additionally. The therapeutic effects were compared at the end of first session of treatment for 4 weeks and 12 weeks after the first session of treatment. The Fugl-Meyer motor assessment scale (FMA), modified Barthel Index (MBI) and Stroke-Specific Quality of Life Scale ( SS-QQL) were taken as the main evaluation indexes. Results The differences of FMA, MBI and SS-QOL scores were insignificant between the two groups before treatment ( P>0.05). At the end of treatment for 4 weeks, FMA, MBI and SS-QOL scores were increased in the two groups (P<0.05), and the increase was more obvious in the observation group (P<0.05). The results of follow-up till the 12th week showed that FMA, MBI and SS-QOL scores were still higher than the baseline level ( P<0.05). Conclusion Consciousness-restoring needling combined with comprehensive rehabilitation training has better effect on improving motor function and the activities of daily living of poststroke hemiplegia patients than comprehensive rehabilitation training alone.

Objective To evaluate and compare the imaging quality and diagnostic accuracy of two types of scanning techniques of 256-slice spiral CT angiography, prospective electrocardiogram(ECG)-gated sequence and non ECG-gated high-pitch sequence, used respectively for patients with Stanford type A aortic dissection (AAD) at the root of ascending aorta.Methods A retrospective study was conducted. Sixty-eight patients with AAD were definitely diagnosed by CT angiography were admitted to the Fifth Central Hospital of Tianjin from August 2015 to July 2017, and they were divided into two groups according to different scanning methods: 36 cases of AAD underwent prospective ECG-gated CT angiography (CTA) and 32 patients underwent non ECG-gated high-pitch CTA. A 3-grade scoring system was used to interpret the image quality of the aortic sinus, aortic valve junction zone and coronary artery opening. The CT value and noise value (SD) of aortic root were measured, the image signal to noise ratio (SNR) was calculated and compared with the discovery in exploratory operation; the patients' CTA imaging quality and the coincidence rate of lesion type diagnosis were compared between the two groups.Results All aortic CTA images could meet the diagnostic requirements. The imaging quality scores of aortic sinus, arotic valve junction zone and coronary artery opening images in ECG-gated CTA group were higher than those in non ECG-gated high-pitch CTA group (aortic sinus: 2.94±0.23 vs. 1.89±0.67, sinuscanal junction zone: 2.94±0.23 vs. 1.83±0.70, coronary artery opening images: 2.86±0.35 vs. 1.31±0.52, allP < 0.01); comparisons between the ECG-gated CTA group and non- ECG-gated CTA group in objective indexes, CT value, arotic SD value and SNR at the root of ascending aorta showed there were no statistically significant differences [the value of CT (HU): 425.20±94.38 vs. 439.29±86.78, the SD value of aorta (HU): 22.85±9.40 vs. 26.40±9.41, SNR: 21.23±8.16 vs. 19.70±9.98, allP > 0.05]. The coincidence rate between the diagnosis of AAD at the root of ascending aorta and the discovery in the exploratory operation in ECG-gated CTA group was higher than that in non ECG-gated CTA group [94.4% (34/36) vs. 68.8% (22/32),P < 0.01].Conclusion The diagnostic accuracy and image quality of AAD root of ascending aorta in prospective ECG-gated CTA group were significantly higher than those in non ECG-gated CTA group.

Objective:To observe the effect of combining scalp acupuncture with feedback training on muscle tone, motor ability, plantar pressure distribution and joint range of motion of stroke survivors with lower limb spastic paralysis.Methods:A total of 212 stroke survivors were randomly divided into a combination group ( n=70), an exercise group ( n=70) and a scalp acupuncture group ( n=72) according to a random number table. All of the patients received routine medication and 120 minutes of rehabilitation training six days a week for 8 consecutive weeks. The rehabilitation training included guidance on good posture, posture change training, balance training and gait training. The scalp acupuncture and exercise groups were additionally provided with 40 minutes of scalp acupuncture and lower limb intelligent feedback training, while the combination group was given both. Muscle tension, balance and lower extremity movement were quantified before and after the training, and a gait evaluation system was used to detect the plantar pressure distribution on the affected side and the range of motion range of the lower limb joints during walking. Results:After the treatment, significant differences were observed in the average modified Ashworth scores, modified Berg scale scores, Fugl-Meyer lower extremity ratings and modified Barthel Index scores compared with before the treatment. The average scores of the combination group were then significantly better than those of the other two groups. The average load bearing ratios of the affected toes, metatarsal bones Ⅰ-V, medial arch, external arch, medial heel and external heel had improved significantly in all of the groups, with the improvement of the combination group again significantly greater than those of the other groups. The same pattern of improvement was observed in the groups′ average pelvic rotation angles, hip flexion angles, knee flexion angles and ankle dorsiflexion angles.Conclusion:Combining scalp acupuncture with intelligent feedback can significantly improve lower extremity functioning after a stroke. That should improve performance in the activities of daily living of stroke survivors.

Objective To explore the safety and efficacy of endovascular treatment(EVT)in patients with acute posterior circulation ischemic stroke over 24 hours from onset.Methods This retrospective study retrospectively analyzed patients with acute posterior circulation ischemic stroke who received EVT in the Department of Neurology,First Hospital of Jilin University from June 2018 to June 2023.The patient's gender,age and other related demographic information were collected.The related examination results of patients were collected,including admission rapid blood glucose,admission systolic blood pressure,admission diastolic blood pressure.The related risk factors of stroke of patients were collected,including previous transient ischemic attack,hypertension,diabetes,atrial fibrillation,and history of drinking,smoking history,etc.;other related indicators were collected,including intravenous thrombolysis,tandem lesions,awakening stroke,baseline National Institutes of Health stroke scale(NIHSS)score,and baseline posterior circulation Alberta stroke program early CT score(pc-ASPECTS),collateral circulation grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR),onset to EVT puncture time,the trial of org 10172 in acute stroke treatment(TOAST)classification and outcome indicators(efficacy indicators included 90 days Modified Rankin scale[mRS]score≤3 after EVT,successful recanalization[extended cerebral infarction thrombolytic recanalization class 2b-3];security indexes included symptomatic intracranial hemorrhage[sICH]within 24 h after EVT and 90 d mortality after EVT).According to the symptom onset to EVT puncture time,the patients were divided into two groups:≤24h group and＞24h group.The patients with onset time＞24 h and those with onset time≤24 h were matched at a ratio of 1:1 by propensity score matching(PSM).All patients were divided into poor prognosis group(mRS score＞3)and good prognosis group(mRS score ≤ 3)according to mRS score at 90 days after EVT.Using univariate and multivariate Logistic regression was used to analyze the effect of onset time on clinical outcomes at 90 days after EVT.Results A total of 366 patients were enrolled in this study,including 284 males and 82 females.The median age was 61(55,68)years old,ranging from 25 to 91 years old.Before PSM,the＞24h group had lower prevalence of atrial fibrillation(2.02％[2/99]vs.9.74％[26/267],P=0.025)and lower baseline NIHSS score(10.0[5.0,19.0]vs.14.0[10.0,35.0],P＜0.01)and higher ASTIN/SIR collateral grade(P=0.018).After PSM,we did not find statistical difference between the two groups in baseline characteristics except for the onset to EVT puncture time.Before and after PSM,there was no significant difference in efficacy and safety between the onset time＞24 h group and the onset time ≤24h group.Univariate binary Logistic regression analysis showed that hypertension(OR,0.613,95％CI 0.391-0.942,P=0.025),intravenous thrombolysis(OR,3.235,95％CI 1.316-9.237,P=0.010),baseline NIHSS score(OR,0.975,95％CI 0.957-0.988,P＜0.01),baseline pc-ASPECTS(OR,1.281,95％CI 1.101-1.482,P=0.001)and sICH within 24 h after EVT(OR,0.070,95％CI 0.000-0.330,P＜0.01)were significantly correlated with prognosis.Gender,age,hypertension,baseline NIHSS score,intravenous thrombolysis,baseline pc-ASPECTS,ASTIN/SIR collateral grade,onset time＞24 h and sICH within 24 h after EVT were included in the multivariate binary Logistic regression analysis.The multivariate binary Logistic regression analysis showed that the onset time＞24 h was not associated with poor prognosis 90 d after EVT(aOR,1.635,95％CI 0.936-2.893,P=0.087).Conclusion EVT for acute posterior circulation ischemic stroke more than 24 hours after onset is feasible under strict imaging screening,and its safety and efficacy are similar to those in patients with onset under 24 hours.

BACKGROUND:In recent years,High-definition transcranial direct current stimulation(HD-tDCS)has garnered significant attention due to its potential non-invasive modulation of brain function.However,there is still a lack of visual analysis in the literature regarding this technique. OBJECTIVE:To perform a visual analysis of HD-tDCS-related research so as to explore the current status and trends in this field. METHODS:English literature related to HD-tDCS was retrieved from the Web of Science Core Collection database covering the period from January 1,2010 to May 6,2023.The VOSviewer software was used to visualize and analyze the source journals,countries/regions,authors,institutions,cited references,and keywords of the included literature,creating a knowledge map to uncover the research landscape and hotspots. RESULTS AND CONCLUSION:A total of 336 articles were included,showing a consistent increase in the annual publication count of HD-tDCS research.Among these,the United States contributed the highest number of publications(141 articles)with 4 221 citations,followed by China with 70 articles and 401 citations.Brain Stimulation was the most prolific journal(28 articles),Marom Bikson was the most productive author(37 articles),and The City College of New York was the most active institution(35 articles).The most frequently mentioned keywords in the field included motor cortex,regulation,working memory,excitability,and dorsolateral prefrontal cortex.Notable recent keywords in the last 5 years include attention-deficit/hyperactivity disorder,brain networks,and stimulation intensity.Currently,the volume of HD-tDCS research is relatively limited,but is on an upward trajectory,indicating substantial research potential.It is expected that future studies in this domain will continue to focus on the application of HD-tDCS in cognitive and neuropsychiatric disorders,while also exploring its therapeutic mechanisms targeting the motor cortex and dorsolateral prefrontal cortex based on brain network analysis.

At present, neuroimaging and neuroelectrophysiology are the main objective detection techniques of brain consciousness; and neuroimaging includes functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS). As a new non-invasive optical neuroimaging technology, fNIRS has more application prospects than fMRI: it can clear the cerebral cortex activation in resting state or different task states, such as real movement, motor imagination, or mental arithmetic; it can not only assess the consciousness horizontally, but also evaluate the effect of rehabilitation therapy vertically. In this paper, the application status of fNIRS in assessing consciousness of disorder is reviewed to explore new technical evaluation means for disorder of consciousness.