Objective To investigate the effect of core stabilization exercises( CSE) on knee osteoarthritis. Methods Sixty cases patients with knee osteoarthritis were randomly divided into treatment group (n = 30)and control group(n = 30). Patients in control group were accepted conventional therapy including conventional physiotherapy,acupuncture,and massage,while in treatment group were accepted CSE besides conventional therapy. All patients were assessed with Lysholm Knee Scoring Scale(LKSS)and Visual Analogous Scale(VAS)before and after treatment. Results VAS in treatment group before and after treatment were(8. 31 ± 1. 16)and(3. 37 ± 0. 97),and the difference was statistically significant( t = 16. 30,P = 0. 00). VAS in control group before and after treatment VAS were(8. 26 ± 1. 22)and(5. 06 ± 0. 82),and the difference was statistically significant( t = 12. 19,P = 0. 000. VAS in two groups after treatment was statistically significant (t = - 6. 98,P = 0. 00). LKSS in treatment group before and after treatment were(32. 92 ± 4. 21),(60. 19 ± 4. 42),and the difference was statistically significant(t = - 30. 44,P = 0. 00). LKSS in control group before and after treatment was(34. 82 ± 5. 58),(53. 49 ± 3. 66),and the difference was statistically significance (t = - 14. 82,P = 0. 00). After the treatment,LKSS in the two groups was significant difference(t = 7. 16,P= 0. 00). Conclusion The core stability training can improve the patients with knee osteoarthritis of knee joint function,relieve pain.

The various mechanisms of kyphosis of the spine and the differential diagnosis of related diseases to guide the selection of appropriate surgical timing, correct spinal osteotomy and reasonable surgical methods. The 24 patients with kyphosis from January 2016 to January 2018 were diagnosed. All patients underwent kyphosis orthopedics, mainly spinal wedge osteotomy, to obtain orbital purpose by wedge osteotomy. The indexes of the spine form, activity, and pain were observed after operation. Of the 24 patients with kyphosis, 5 patients were treated conservatively, and the symptoms of kyphosis were effectively relieved. 19 patients underwent kyphosis orthopedic surgery, and the anterior spine and posterior closed osteotomy. The patients recovered well after surgery and were followed up regularly. The treatment of high anterior spine and posterior closed osteotomy in patients with kyphosis has accurate surgery effect. There are no complications such as pain and internal fixation during the regular follow-up.

OBJECTIVE: To evaluate the value of multi-slice CT angiography (MSCTA) in the diagnosis of super mesenteric artery (SMA) and super mesenteric vein (SMV), and discuss the 3D reconstruction method for detecting mesenteric vessel lesions. METHODS: Thirty-three patients suffering from mesenteric vessel diseases were analyzed. There were 14 SMA lesions, including 9 thromboses, 3 dissecting aneurysms, 1 pseudoaneurysm, and 1 malrotation. There were 19 SMV thromboses. The 3D reconstruction included volume rendering (VR), maximum intensity projection (MIP), and multi-planner reformation (MPR). RESULTS: The lesions appeared clear by MSCTA in the 33 patients. The SMA thrombosis was shown clear in the MIP in all 9 patients, and only 4 of them were detected in the VR. There was significant difference between MIP andVR in detecting SMA thrombosis (P=0.0294). Three dissecting aneurysms were best shown in the MPR; 1 pseudoaneurysm and 1 malrotation were clearly manifested in the VR. The thrombosis of SMV was clearly shown by both MIP and MPR in all 19 patients. Collateral vessels were clearly shown in the MIP in 12 patients; the collateral vessels were detected by VR only in 5, and the other 7 failed to show the collateral vessels. There was significant difference between the MIP and the VR in showing lateral collateral vessels (P=0.0046). CONCLUSION Both lesions of SMA and SMV can be detected by MSCTA. MIP is an ideal reconstruction method for SMA thrombosis and collateral vessels around the SMV.
Aneurysm, Dissecting ; diagnosis ; Angiography ; Humans ; Mesenteric Arteries ; pathology ; Mesenteric Veins ; pathology ; Thrombosis ; diagnosis ; Tomography, X-Ray Computed

Objective To observe the effect of ultrasound-guided transversus abdominis plane block combined with diclofenac sodium suppository in anus on postoperative analgesia and early recov-ery after laparoscopic hysterectomy.Methods Sixty-six patients of laparoscopic hysterectomy,aged 40-60 years,were randomly divided into group T and group D,33 cases in each group.Group T used ultrasound-guided bilateral transversus abdominis plane (TAP)block after surgery.Group D used TAP block and diclofenac sodium suppositories in anus.All patients received PCIA.Postoperative 24 h sufentanil dosage out of analgesia pump and the effective press times were recorded.The incidence of dysphoria,nausea and vomit within postoperative 24 h,the time of first out-of-bed activity,the time of first anal exhaust and the time of removing urine tube were measured.The plasma concentra-tion of interleukin-6(IL-6),C reactive protein (CRP)and cortisol (Cor)were recorded at the follow-ing four time points:before anesthesia,just postoperative moment,8 and 12 h after surgery. Results Compared with group T,the sufentanil dosage [(18.6±3.2)μg vs (40.8±5.1)μg]and the effective press times [(9.3±2.2)times vs (20.4±3.5)times]were fewer in group D (P<0.05).The incidence of dysphoria,and nausea and vomit were less in group D compared with group T (P<0.05).The IL-6,CRP and Cor of group D at 12 h were lower than those of group T (P<0.05). But the times of first out-of-bed activity,anal exhaust and removing urine tube in two groups were not significantly different.Conclusion Transversus abdominis plane block combined with diclofenac sodium suppositories in anus can provide safe and effective postoperative analgesia for laparoscopic hysterectomy,and promote the early fast recovery.

Copy number variants (CNVs) are common causes of human genetic diseases. CNVs detection has become a routine component of genetic testing, especially for pediatric neurodevelopmental disorders, multiple congenital abnormalities, prenatal evaluation of fetuses with structural anomalies detected by ultrasound. Although the technologies for CNVs detection are continuously improving, the interpretation is still challenging, with significant discordance across different laboratories. In 2020, the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen) developed a guideline for the interpreting and reporting of constitutional copy number variants, which introduced a quantitative, evidence-based scoring framework. Here, we detailed the key points of interpreting the copy number gain based on the guideline, used six examples of different categories to illuminate the scoring process and principles. We encourage a professional understanding and application of this guideline for the detected copy number gains in China in order to further improve the clinical evaluation accuracy and consistency across different laboratories.
Child ; DNA Copy Number Variations ; Female ; Genetic Testing ; Genetics, Medical ; Genome, Human/genetics* ; Genomics ; Humans ; Pregnancy ; United States

Objective:To investigate the clinical efficacy of posterolateral approach combined with anteromedial approach in the treatment of trimalleolus fracture.Methods:A retrospective analysis was performed of the 20 patients who had been admitted to The Second Department of Orthopedics, The First People's Hospital of Tianshui for trimalleolus fractures from January 2016 to August 2020. They were 16 men and 4 women, aged from 20 to 70 years (average, 49.6 years). The lateral malleolus, posterior malleolus and medial malleolus were treated with reduction and internal fixation using the posterolateral approach combined with the anteromedial approach. Postoperative complications were observed, and the foot function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and pain visual analog scale (VAS).Results:In this cohort, the operation time ranged from 85 to 115 minutes, averaging 88.4 minutes and the intraoperative blood loss from 50 to 600 mL, averaging 120 mL. All patients were followed up for 12 to 20 months (mean, 14.5 months). The fracture healing time ranged from 3.2 to 5.4 months, averaging 3.8 months. Follow-ups observed no such complications as infection or necrosis of surgical incision, failure of internal fixation, nonunion, or malunion. The AOFAS ankle-hindfoot score at 12 months after operation (87.8±6.4) was significantly higher than that before operation (32.3±4.9) ( t=29.454, P<0.001); as for VAS, one case scored 0, 13 cases 1 to 3 points and 6 cases 4 points. Conclusion:In the treatment of trimalleolus fracture, a combination of posterolateral approach and anteromedial approach can lead to definitely positive efficacy because of a significant reduction in operation time, intraoperative bleeding and postoperative complications.

Reports a case admitted in the Ward I of Department of Surgery of Zhengzhou Renji Hospital in June 2017. A young child who suffered destructive injury of left forearm, wrist and palm with severed 3rd-5th fingers. Tendon and neurovascular repairs of forearm, wrist and palm were performed with pedicled abdomina flap and the 3rd-5th fingers ectopic replantation in Phase I surgery. In the Phase II surgery, the abdomina flap division was carried out. The replantation of severed fingers after ectopic replantation and the reconstruction of foot defect with free anterolateral thigh flap(ALTF) were carried out in Phase III surgery. In Phase IV surgery, fingers functional reconstruction and foot flap thinning were performed. Four years after surgery, the thumb oppositions to middle, ring and little fingers could be completed, with slightly limitations. The appearance and texture of transferred foot flap were good, and the child could walk and run almost normally.

Objective:To construct the competency evaluation index system for endoscopic specialized nurses and provide basis for training, assessment and performance evaluation of endoscopic specialized nurses.Methods:In March 2021, through literature review, research group discussion, expert interview and satisfaction questionnaire, the competency evaluation system for endoscopic specialized nurses was initially established. From March to December 2021, experts from four provinces were selected by convenient sampling for two rounds of Delphi expert consultation. The weight of each indicator was determined by the method of precedence chart and analytic hierarchy process.Results:Among two rounds of consultation, the effective recovery rates of the questionnaire were 86.36% (19/22) and 89.47% (17/19) respectively, and the authority coefficients of experts were 0.82 and 0.86 respectively. The Kendall concordance coefficients of experts' opinions on the first, second and third level indicators were 0.40, 0.50 and 0.48 respectively ( P<0.05) . The final index system included 4 first level indicators (professional knowledge, professional skills, professional development ability, personal characteristics) , 18 second level indicators and 73 third level indicators. Conclusions:The competency evaluation index system for endoscopic specialized nurses has high reliability, comprehensive and practical contents, and has certain reference significance for the management and training of endoscopic specialized nurses.

Objective To develop a rapid and accurate Monte Carlo program(simplified code for dosimetry of carbon ions,SPEEDO)for carbon ion therapy.Methods For electromagnetic process,type Ⅱ condensed history simulation scheme and continuous slowing down approximation were used to simulate energy straggling,range straggling,multiple scattering,and ionization processes.For nuclear interaction,5 types of target nuclei were considered,including hydrogen,carbon,nitrogen,oxygen,and calcium.The produced secondary charged particles followed the same condensed history framework.The study simulated the transport of carbon ions in 4 materials(water,soft tissues,lung,and bone),and the calculated doses were validated against TOPAS(a Monte Carlo simulation software for radiotherapy physics),followed by a comparison with dose measurements in a water phantom from the HIMM-WW(a medical heavy-ion accelerator facility in Wuwei).Results SPEEDO's simulation results showed good consistency with TOPAS.For each material,in the voxel region where the physical dose was greater than 10％of the maximum dose point,the relative maximum dose error of both was less than 2％.At treatment energy of 400 MeV/u,SPEEDO's computation time was significantly less than that of TOPAS(13.8 min vs 105.0 min).SPEEDO's calculation results also showed good agreement with HIMM-WW measurements in terms of lateral dose distribution and integrated dose depth curve.Conclusion SPEEDO program can accurately and rapidly perform Monte Carlo dose calculations for carbon-ion therapy.

Background/Aims: The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation. Methods: Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles. Results: FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012). Conclusions FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.