AIM:To evaluate the effectiveness of EYESI binocular indirect ophthalmoscope simulation system as a training platform for fundus examination skills of general practitioner.METHODS:Prospective randomized study. A total of 40 general practitioners who received clinical ophthalmology training at Shenzhen Eye Hospital from January 2021 to December 2024 were selected and randomly divided into two groups by random number table method, with 20 cases in the study group and 20 cases in the control group. The study group was trained by EYESI binocular indirect ophthalmoscope simulation system and the control group was trained by conventional teaching. Training effects of the two groups were analyzed.RESULTS: The general information of the two groups was comparable. Through training with the EYESI binocular indirect ophthalmoscope simulator, the study group showed significant improvements in total examination and drawing scores compared to pre-training results(all P<0.001). Additionally, examination duration, retinal light exposure time, and drawing time were all significantly shorter than those before training(all P<0.001).The study group achieved significantly higher total examination and drawing scores than the control group during the EYESI binocular indirect ophthalmoscope simulator assessment(all P<0.001). Furthermore, examination duration, retinal light exposure time, and drawing time were all significantly shorter in the study group compared to the control group(all P<0.001). Moreover, ratings for the novelty of the training method and overall satisfaction with the training were significantly higher in the study group than in the control group(all P<0.001); while the perceived psychological stress during training was significantly lower in the study group(P<0.001).CONCLUSION:The EYESI binocular indirect ophthalmoscope simulaton system effectively enhances both the proficiency in fundus examination skills and overall training satisfaction among general practitioners.

【Objective】 To investigate the effect and mechanism of achyranthes bidentata polysaccharides （ABPS） on the differentiation of bone mesenchymal stem cells （BMSCs） into nucleus pulposus-like cells. 【Methods】 Five 4-week-old SD rats were sacrificed and their BMSCs were isolated and purified by repeated adherent method. The third-generation BMSCs were treated with different concentrations of ABPS for 48 h. The cell viability was detected by MTT method. The highest concentration of ABPS was selected for subsequent experiments. According to different treatment methods， cells were divided into control group （conventional culture）， ABPS group （200 mg/L of ABPS）， Notch1 group （transfected with Notch1）， Notch1 negative control group （transfected with Notch1 negative control）， and ABPS+Notch1 group （200 mg/L of ABPS was added after transfection with Notch1）. After 14 days of induction， the cell survival rate was measured by MTT method. CollagenⅡ was detected by immunohistochemical staining. The mRNA and protein expression levels of collagenⅡ， aggrecan， Notch1 and Hes1 were detected by qPCR and Western Blotting respectively. The glucosaminoglycan （GAG） was detected by alcian blue method on the 1st， 4th， 7th， 10th and 14th day of cell culture. 【Results】 After BMSCs were treated with 400 mg/L of ABPS for 48 h， the cell survival rate was significantly lower than that in the control group （P<0.05）. When the concentration was ≤200 mg/L， ABPS had no significant toxic effect on the growth of BMSCs. After 14 days of induction， compared with the control group， A value， GAG content in the medium， the expressions of collagen II and aggrecan mRNA and protein in the ABPS group were increased， and the expressions of Notch1 and Hes1 mRNA and protein were decreased （P<0.05）. The relative cell viability， GAG content in the medium， the expressions of collagen II and aggrecan mRNA and protein in the Notch1 group were decreased， and the expressions of Notch1 and Hes1 mRNA and protein were increased （P<0.05）. ABPS+Notch1 could partially reverse the inhibitory effect of Notch1 overexpression on the differentiation of BMSCs into nucleus pulposus-like cells. 【Conclusion】 ABPS can promote the differentiation of BMSCs into nucleus pulposus-like cells， and the mechanism may be related to the inhibition of Notch1 pathway.

BACKGROUND: Studies have shown that bone marrow mesenchymal stem cells (BMSCs) can differentiate into nucleus pulposus-like cells, but the mechanism of differentiation is not clear. OBJECTIVE: To induce bone BMSCs into nucleus pulposus-like cells using Achyranthes bidentata Bl. saponins (ABS) and to explore the role of Nampt/NAD/Sirt1 axis in the differentiation of BMSCs. METHODS: BMSCs were collected from Sprague-Dawley rats. Cells at passage 3 were divided into four groups: BMSCs group, BMSCs+ABS group, BMSCs+ABS+nicotinamide mononucleotide (an exogenous small molecule substance promoting NAD synthesis) group, BMSCs+ABS+FK866 (nicotinamide phosphoribosyltransferase inhibitor) group, in which the cells were induced for 14 days. Alcian blue staining was used to show the changes of glycosaminoglycan in the cells. RT-PCR was used to detect the mRNA expression of COL2, Aggrecan, KRT19, Pax1. The protein expression level of COL2 was detected by western blot. The activity of Sirt1 was detected by Sirt1 assay kit and the content of NAD+ was measured by NAD+/NADH kit. RESULTS AND CONCLUSION: (1) Compared with the BMSCs group, BMSCs+ABS group showed significant increases in the expression levels of glycosaminoglycan, Aggrecan, KRT19, and Pax1 (P < 0.05), and the protein expression levels of COL2, activity of Sirt1, and content of NAD+ were also significantly increased (all P < 0.05). (2) Compared with the BMSCs+ABS group, the above-mentioned indicators were significantly increased in the BMSCs+ABS+nicotinamide mononucleotide (P < 0.05); on the contrary, these indicators were all decreased significantly in the BMSCs+ABS+FK866 group (P < 0.05). To conclude, ABS could induce the differentiation of rat BMSCs into nucleus pulposus-like cells, in which the Nampt/NAD/Sirt1 axis might play a promotion role.

Objective: To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis. Methods: Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate. Results: In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05). Conclusion The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery.

Objective To explore effect of 5-HT,VEGF and mineral content in osteoporosis rat by Morinda officinalis.Methods 90 SPF male SD rats were selected, 15 rats were randomly selected as the normal control group, the rest were to establish the model of osteoporosis.When the model was established successfully according to the different treatment methods were divided into control group, model group, positive medicine group, low, middle and high does group.Bone mineral density, 5-HT, VEGF and the levels of the mineral were compared after 4 weeks treatment.Results Compared with the normal control group, BMD of model control group and low dose group was lower, Compared with the positive drug group, BMD of middle dose and high dose was higher ( P<0.05 ).Compared with model group,5-HT level of positive medicine group, high dose group and middle dose group was higher, compared with positive drug group, 5-HTP of middle dose group and high dose group was higher ( P <0.05 ).Compared with model group, positive drug group, VEGF levels of middle dose group and high dose group were higher(P <0.05), compared with positive drug group, VEGF of middle dose group and high dose group were higher(P<0.05), compared with model control group, positive drug group, serum P content of middle dose group was higher, compared with positive drug, serum P content of high dose group and high dose group was less.Conclusion Morindae Officinalis can increase 5-HT, VEGF in a rat model of osteoporosis, improve the level of serum P, has the guiding sense to the clinical.

Objective To compare the efficacy of self-made bone cement spacers containing vancomycin(vancomycin spacer)and Link infection-treating spacers(Link type spacer)for chronic infection after total hip arthroplasty(HTA)and investigate the choice of spacers for the two-stage revision of infection.Methods The study included 26 patients with infection combined with HTA,aged 32-82 years(mean 69.5 years).In the first stage,after complete debridement and removal of infected prostheses,the vancomycin spacers were implanted in 14 patients,while the Link type spacers were implanted in the rest 12 patients.Two weeks of intravenous administration of antibiotics and then six weeks of oral administration of antibiotics were done postoperatively.White blood cells(WBCs),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were measured periodically after operation.THA revision was performed in the second stage.Clinical outcomes were evaluated according to the pre-and post-operative Harris hip score.Results All patients obtained primary healing of incision after complete debridement,removal of prostheses and implant of the vancomycin spacers or the Link type spacers.Two-stage revision surgery was performed at 3-11.5 months after the one-stage surgery(mean 5.2 months).The follow-up ranging from 12 to 33 months(mean 20.8 months)manifested no signs of reinfection.The mean Harris hip score was increased from 27.9 points before one-stage operation to 52.9 points before two-stage operation,and 83.6 points at the latest follow-up(P＜0.05)One of 12 vancomycin spacers was broken before the revision surgery,as was free from the Link spacers.Conclusions(Ⅰ)Two-stage revision is an effective method in the treatment of infection after HTA because of high eradication rate of infection,effective pain relief and good postoperative functional result.(2)The vancomycin spacers and the Link type spacers can both effectively control infection and restore part of limb function.(3)The Link type spacers take advantages of simple in operation and the function improvement of the limbs during the intermittent period of treatment,but disadvantages of the catheters being prone to block,limited slow release of antibiotics and high cost of treatment.Thereby,the Link type spacer is suitable for the patients with relatively strong constitution,little serious infection,or high requirement of limb functions at the interval of two operations.