Objective To explore the reliability of the modified Penn spasm frequency scale (MPSFS),the spinal cord assessment tool for spasticity (SCATS),the spinal cord injury spasticity evaluation tool (SCI-SET) and visual analogue scales (VASs) and their inter-correlation so as the provide evidence for clinical application.Methods The spasticity of thirty-five patients with spinal cord injury was assessed by 2 raters using the 4 scales with an interval of half an hour between assessments.Three days later,all of the subjects were again evaluated by one of the 2 raters in the same environment.The intra-class correlation coefficient (ICC),standard error of measurement (SEM) and minimal detectable difference (MDD95) were calculated,and the correlations among the 4 scales were analyzed.Results The test-retest ICC for the MPSFS was 0.94 and the inter-rater reliability ICC was 0.90.For the SCATS they were 0.948 and 0.939 respectively.,For the VAS they were 0.962 and 0.974,and for the SCI-SET they were 0.969 and 0.989.There was significant inter-correlation among all four scales,with negative correlation between the SCI-SET and the others.The observed correlations were all of medium strength (r=-0.421 to-0.5),except for a high correlation between the SCI-SET and VAS results (r=0.55 to 0.94).Conclusion The MPSFS,SCATS,VAS and SCI-SET are all reliable tools for evaluating spasticity among people with spinal cord injury.All can be applied in clinical practice.

Objective To observe the clinical efficacy of pestle acupuncture at Yao Yang Guan Ba Zhen and He Che Ming Qiang Duan in treating lumbago due to cold and damp. Methods Totally sixty-two patients with lumbago due to cold and damp were randomized into a treatment group and a control group, 31 in each group. The two groups were both intervened by medicinal fumigation, while the treatment group was additionally treated with pestle acupuncture at Yao Yang Guan Ba Zhen and He Che Ming Qiang Duan and the control group was additionally with ordinary acupuncture. Visual Analogue Scale (VAS) was observed before and after intervention, and the clinical efficacies were compared. Results The total effective rate was 90.3%in the treatment group versus 87.1% in the control group, and the difference was statistically significant (P<0.05). The VAS scores were significantly changed after intervention in both groups (P<0.01). After intervention, there was a significant difference in comparing VAS score between the two groups (P<0.05). Conclusions Pestle acupuncture is an effective method in treating lumbago due to cold and damp, and it doesn’t cause any injury or pain.

Objective: To observe the clinical effect of pestle needle combined with Chinese herbal fumigation on cervical spondylosis and provide a safe effective therapy for this condition. Methods: A total of 54 cases were randomly allocated into two groups (27 cases in each group) according to their sequence of consultation. Patients in both groups were treated with the same Chinese herbal fumigation. Patients in the treatment group were additionally treated with pestle needle therapy on a unique set ofBa Zhen points around Dazhui (GV 14), Fengfu (GV 16) and the distance between Naohu (GV 17) and Dazhui (GV 14) along theHe Chepathway, whereas patients in the control group were additionally treated with routine acupuncture therapy. Then the short-term and long-term efficacies were observed and compared after treatment using the visual analog scale (VAS) and pain rating index (PRI). Results: At the end of treatment, VAS scores were significantly decreased in both groups, and the VAS score in the treatment group was lower than that in the control group (P<0.05). The intra-group differences were statistically significant in VAS scores 1 month, 3 and 6 months after treatment (allP<0.05). At the end of treatment, the sensory and total PRI scores in the treatment group were significantly lower than those in the control group, showing statistically significant differences (both P<0.01); and there was no significant between-group difference (P>0.05) in the affective PRI score. At the end of treatment, the total effective rate was 85.2% in the treatment group, versus 65.4% in the control group, showing a statistical significance (P<0.05). The follow-up six months later showed that the total effective rate was 92.6% in the treatment group, versus 76.9% in the control group, showing a statistical significance (P<0.05). Conclusion: Pestle needle therapy is a stable and positive therapy for cervical spondylosis.

Objective:There is no standard method for esophageal remnant gastric reconstruction for proximal gastrectomy. Reflux esophagitis caused by esophagogastrostomy remains a difficult surgical problem. To report the preliminary surgical results of novel esophagus-conical remnant gastric side overlap anastomosis (CGEO) , with particular emphasis on postoperative esophageal reflux.Methods:In June 2022, we developed a novel CGEO for laparoscopic proximal gastrectomy on two patients with Siewert type II esophagogastric junction adenocarcinoma. Surgical procedures for CGEO: (1) Laparoscopic proximal gastrectomy and preparation of conically shaped gastric remnant; (2) Determining anastomotic site of residual stomach and esophagus; (3) Side-to-side anastomosis of right esophageal wall to anterior of conical gastric remnant; (4) Valvuloplasty of esophageal stump.Results:Case 1 was a 71-year-old man with an operation time of 305 minutes and was successfully discharged from the hospital on the 9th day after surgery, and the postoperative pathology was T3N0M0. Case 2 was an 82-year-old man with an operation time of 325 minutes. He was discharged on the 10th day after surgery. In both cases, only mild esophageal mucosal changes were seen in gastroscopy, there were no obvious symptoms of esophageal reflux. There was also no significant weight change at half a year after operation.Conclusion:CGEO is moderately safe in radical surgery for proximal gastric cancer, and may have a preventive effect on the occurrence of postoperative esophageal reflux, but long-term results need to be confirmed by further studies with follow-up.

Objective:To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty (OSF) for reconstruction after laparoscopic proximal gastrectomy.Methods:The C-shaped seromuscular flap (2.5 × 3.5 cm), which was 2 cm from the top of the remnant stomach, was extracorporeally created on the anterior wall of the remnant stomach. The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap. Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa. Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm. Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole. Finally, the seromuscular flap was closed using barbed sutures.Results:Clinical data of 11 patients with Siewert type II esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected. There were 7 males and 4 females. The average age was (69.9±7.8) years, the BMI was (21.7±7.2) kg/m 2 and the tumor size was (2.1±0.6) cm. OSF reconstruction was successfully completed in all 11 patients. The median operative time was 275 (270-428) minutes, the time for OSF reconstruction was 112 (80-140) minutes, and the blood loss was 50 (20-400) ml. The pathological stage was 0-I in 7 cases and II-III in 4 cases. The patients were fed on the 4th day (4-7 days) and discharged from hospital on the 7th day (6-9 days) after surgery. No patient had gastroesophageal reflux symptoms of grade B and above, and no patient took anti-reflux medicine. Conclusions:OSF is a safe and feasible treatment for Siewert type II esophagogastric junction adenocarcinoma.

Objective:There is no standard method for esophageal remnant gastric reconstruction for proximal gastrectomy. Reflux esophagitis caused by esophagogastrostomy remains a difficult surgical problem. To report the preliminary surgical results of novel esophagus-conical remnant gastric side overlap anastomosis (CGEO) , with particular emphasis on postoperative esophageal reflux.Methods:In June 2022, we developed a novel CGEO for laparoscopic proximal gastrectomy on two patients with Siewert type II esophagogastric junction adenocarcinoma. Surgical procedures for CGEO: (1) Laparoscopic proximal gastrectomy and preparation of conically shaped gastric remnant; (2) Determining anastomotic site of residual stomach and esophagus; (3) Side-to-side anastomosis of right esophageal wall to anterior of conical gastric remnant; (4) Valvuloplasty of esophageal stump.Results:Case 1 was a 71-year-old man with an operation time of 305 minutes and was successfully discharged from the hospital on the 9th day after surgery, and the postoperative pathology was T3N0M0. Case 2 was an 82-year-old man with an operation time of 325 minutes. He was discharged on the 10th day after surgery. In both cases, only mild esophageal mucosal changes were seen in gastroscopy, there were no obvious symptoms of esophageal reflux. There was also no significant weight change at half a year after operation.Conclusion:CGEO is moderately safe in radical surgery for proximal gastric cancer, and may have a preventive effect on the occurrence of postoperative esophageal reflux, but long-term results need to be confirmed by further studies with follow-up.

Objective:To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty (OSF) for reconstruction after laparoscopic proximal gastrectomy.Methods:The C-shaped seromuscular flap (2.5 × 3.5 cm), which was 2 cm from the top of the remnant stomach, was extracorporeally created on the anterior wall of the remnant stomach. The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap. Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa. Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm. Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole. Finally, the seromuscular flap was closed using barbed sutures.Results:Clinical data of 11 patients with Siewert type II esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected. There were 7 males and 4 females. The average age was (69.9±7.8) years, the BMI was (21.7±7.2) kg/m 2 and the tumor size was (2.1±0.6) cm. OSF reconstruction was successfully completed in all 11 patients. The median operative time was 275 (270-428) minutes, the time for OSF reconstruction was 112 (80-140) minutes, and the blood loss was 50 (20-400) ml. The pathological stage was 0-I in 7 cases and II-III in 4 cases. The patients were fed on the 4th day (4-7 days) and discharged from hospital on the 7th day (6-9 days) after surgery. No patient had gastroesophageal reflux symptoms of grade B and above, and no patient took anti-reflux medicine. Conclusions:OSF is a safe and feasible treatment for Siewert type II esophagogastric junction adenocarcinoma.

Objective: To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery, and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus(iNPH). Methods: Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery, and were evaluated by using 3-meter timed up and go test(TUG), minimum mental state examination(MMSE), idiopathic normal pressure hydrocephalus grading scale(iNPHGS)and modified Rankin scale(mRS)before and one year after CSF shunt procedures.The ventricular volume, brain volume, pericerebral CSF volume, total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated: the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume. Results: The scores of gait, cognitive function and urinary function were improved after surgery in iNPH patients(all P<0.05). There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait, cognitive function and urinary function before surgery, and with the degree of symptom improvement one year after surgery in iNPH patients(all P>0.05). There was no significant difference in intracranial compartment volumes between patients having improvement in mRS, TUG, MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P>0.05). Conclusions Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait, cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery, and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason, preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.