[Objective] To enhance the understanding of the diagnosis of benign tumor in the knee joints.[Method] Thirteen patients(9 males and 4 females,aged 7 to 49 years,38.2 years arerage)with tumor in the knee joints were diagnosed and treated under arthroscopy since 1996.There were 3 with the synovial hemangioma,2 with tensoynovial giant cell tumor,4 with ganglion cysts of cruciate ligament and synovial cysts,1 with chondroma in the soft tissue,2 with desmoid tumor in the cruciate ligament and 1 with cruciate ligament desmoid.The curative effects were observed through a follow-up of more than half a year.[Result]All the cases were diagnozed under arthroscope and confirmed by the pathological examinations.All the patients were treated under arthroscope and followed by 11 months to 6 years.Clinical symptom improved obviously and no recurrence was found after the operation.Assessment of the curative effects were 46% excellent,39% good and 15% fair.[Conclusion]Benign tumor in the knee joints is rare.It's often difficult to diagnoze in the clinical practice.Arthroscopy is a very useful method for the diagnosis and treatment of the suspected patients with benign tumor in knee joints.

Objective To observe the adjuvant therapy efficacy of Saccharomyces boulardii sachets in liver cirrhosis patients with spontaneous bacterial peritonitis(SBP).Methods 72 liver cirrhosis patients with SBP were randomly divided into the observation group and control group.The patients in the control group (30 cases) were giv-en routine medical treatment such as anti-infection,correction of hypoproteinemia,liver protection,and diuresis,etc. At the base of the control group,the patients in the observation group (32 cases) were orally given Saccharomyces boulardii ( Baili Pharmaceutical Factory,French) 0.5g for one time,two times daily for 10 days.The changes of serum interleukin-6(IL-6),pmcalcitonin (PCT) and hypersensitive c-reactive protein (hs-CRP) levels in the two groups were observed and compared before and after treatment, and curative effect and safety were also observed. Results Before treatment,the serum IL-6,PCT and hs-CRP levels in the two groups had no obviously statistical difference(all P>0.05),but after treatment,the serum IL-6,PCT and hs-CRP levels of the observation group were much lower than those of the control group[(60.50 ±19.10) pg/mL vs (98.32 ±17.20) pg/mL,(1.80 ± 0.34)μg/L vs (6.38 ±3.56)μg/L,(6.20 ±4.15) mg/L vs (20.28 ±8.30) mg/L,t=8.147,7.246,8.529,all P<0.01].Meanwhile,the total effective rate of the observation group was significantly higher than that of the control group(93.75%vs 73.33%,χ2 =4.771,P<0.05).The incidence rate of DAR between the two groups had no obvi-ously statistical difference(9.38% vs 13.33%,χ2 =0.242,P>0.05).Conclusion Saccharomyces boulardii can significantly reduce serum IL-6,PCT and hs-CRP levels of liver cirrhosis patients with SBP,and reduce inflamma-tion reaction to control development of SBP.

OBJECTIVETo assess the two-year outcome of initial endodontic treatment and evaluate the relationship between the treatment outcome and relevant factors.

METHODSA total of 296 patients with 371 teeth received initial endodontic treatment between January 2005 and December 2007 were included in the study. The teeth were treated using crown down technique, and followed for two years. The outcome was examined clinically and radiographically. The relevant factors, including pulp vitality, apical periodontitis, the number of tooth root, and state of root canal obturation, were analyzed.

RESULTS143 (176 teeth) from 296 patients (371 teeth) were followed for two years. 152 teeth (86.36%) with normal limits were assessed as "healed" (no apical periodontitis, no signs or symptoms). 24 teeth were assessed as "disease", 12 teeth were extracted and 12 teeth were retreated. The healing rate(HR) was statistically higher for vital teeth (95.38%) than that for devital teeth (81.08%). The HR of teeth without apical periodontitis (95.24%) was significantly higher than that with apical periodontitis (73.24%). Other factors were associated with different HR, but no statistical significance (P>0.05).

CONCLUSIONApical periodontitis and pulp vitality may be prognostic factors for outcome of initial endodontic treatment.

Objective To measure the maximum movement of the hyoid bone and ventriculus laryngis during normal swallowing. Methods Forty volunteers were selected as subjects, and an X?ray simulator was used to collect the videos of normal swallowing. Video analysis software was used to capture continuous and quick screenshots of these videos, and the maximum movement of the hyoid bone and ventriculus laryngis was measured. The difference in movement was analyzed by one?way analysis of variance. Results The mean time for swallowing in 40 volunteers was 1.13±0.28 s. During the process of swallowing, the hyoid bone and ventriculus laryngis moved upward first, then outward, and finally returned to the resting position. The maximum movement of the hyoid bone forward and backward was 0.90±0.30 cm;the maximum vertical movement of the hyoid bone was 0.93±0.36 cm. The maximum movement of the ventriculus laryngis forward and backward was 0.69± 0. 25 cm;the maximum vertical movement of the ventriculus laryngis was 1.04±0.45 cm. Further studies showed the effect of age on the time for swallowing (P=0.03), with similar results for the male and female ( P=0.13) . Sex and age had no effects on movement of the hyoid bone and ventriculus laryngis (P=0.28?0.81 and 0.20?0.88). Conclusions During normal swallowing, the hyoid bone and the ventriculus laryngis move first upward and then forward. These movements should be considered during the development of radiotherapy plan for head and neck cancer.

Objective To compare the efficiency and safety of double-channel flexible ureteroscopy and electronic flexible ureteroscopy.Methods From April 2007 to 2016 July, clinical data of 836 cases flexible ureteroscopic holmium laser lithotripsy were collected. All the patients were randomly divided into electronic lfexible ureteroscopy group (n = 427) and double-channel lfexible ureteroscopy group (n = 409), the operation time, success rate of surgery, complications, residual stone rate of the two groups were compared.Results The success rate of surgery was 92.5% and 83.6% of the two groups respectively, the difference was significant (P < 0.05); postoperative systemic inlfammatory response syndrome (SIRS) were occurred in 10 cases and 13 cases respectively, which were cured and the difference was not statistically significant (P > 0.05); the average operation time was (81.1 ± 7.9) min and (95.3 ± 7.6) min respectively, the difference was significant (P < 0.05); The formation of stone street of electronic lfexible ureteroscopy group and double-channel lfexible ureteroscopy group were 17 cases and 25 cases. The residual stone rate of electronic flexible ureteroscopy group and double-channel flexible ureteroscopy group were 6 cases and 8 cases, of them were cleared after extracorporeal shockwave lithotrips (ESWL). There were no difference between the two groups (P > 0.05).Conclusion Both double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy are effective and safe therapeutic modalities. Electronic flexible ureteroscopy is better than double-channel lfexible ureteroscopy in success rate of surgery because of its high deifnition and lfexible operation.

Objective:To investigate the clinical manifestations, risk factors and outcomes of patients with acute cingulate cortex (CC) infarction.Methods:Patients with acute CC infarction admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University from December 2019 to April 2022 were enrolled retrospectively. According to the location of infarction, they were divided into anterior cingulate cortex (ACC) infarction group and posterior cingulate cortex (PCC) infarction group. The clinical manifestations, stroke risk factors, imaging examination and National Institutes of Health Stroke Scale (NIHSS) score of the patients were analyzed. At one month after onset, the modified Rankin Scale was used to evaluate the short-term outcome.Results:A total of 21 patients with acute CC infarction were enrolled, including 12 males (57.14%), aged 67.14±12.36 years (range, 45-89 years). There were 16 patients (76.19%) with ACC infarction, including 13 (81.25%) unilateral CC infarction. The clinical manifestations were mainly apathy, decreased concentration, and executive dysfunction. There were 5 patients (23.81%) with PCC infarction, all with unilateral onset, mainly manifested as memory loss and visual space disorder. Among the 21 patients, 18 (85.71%) had ≥2 vascular risk factors, and 13 patients (61.90%) had ≥3 vascular risk factors, of which hypertension was most common (90.48%); 19 (90.48%) were caused by atherosclerosis, and 2 (9.52%) were caused by cardiogenic embolism. After treatment, the symptoms of both groups were improved significantly, and there was statistical difference in the NIHSS score before and after treatment ( Z=4.07, P<0.01). During the follow-up, 16 patients (76.19%) had a good outcome, 5 (23.81%) had a poor outcome and no death occurred. Conclusions:ACC and PCC infarction mainly showed different forms of cognitive impairment. If the diagnosis and treatment are timely, the overall outcome of CC infarction is good.

Objective To systemically analyze the efficacy and safety of multi-oil fat emulsion injection (SMOF) in the premature infant parenteral nutrition support.Methods Databases including EMbase,PubMed,Cochrane Library,CNKI,VIP and Wanfang,were searched from libraries establishment to November 2017 for randomized controlled trials (RCTs) focusing on the efficacy and safety of SMOF in the premature infant parenteral nutrition support.All the literatures were retrieved and screened according to inclusion and exclusion criteria by two researchers.The software RevMan 5.3 was used for meta-analysis after the evaluation of methodology of quality.Results A total of 7 articles including 7 RCTs were enrolled.Meta-analysis showed that there were no significant differences in body length (OR=-0.25,95％ CI=-1.80-1.30,P=0.75),weight (OR=-0.12,95％ CI=-0.20-0.04,P=0.14),head circumference (OR=0.07,95％ CI=-0.83-0.96,P=0.88),lowdensity lipoprotein,high-density lipoprotein,direct bilirubin,serum creatinine (OR=-0.16,95％ CI=-0.59-0.26,P=0.45) between the infants receiving SMOF or Intralipid.But compared with the infants receiving Intralipid,hemoglobin (OR=-0.75,95％ CI=-1.49-0.00,P=0.05),red blood cells (OR=-0.23,95％ CI=-0.45-0.00,P=0.05) decreased in the infants receiving SMOF,and white blood cells (OR=1.91,95％ CI=0.46-3.37,P =0.01) increased.Conclusions SMOF can control the hemoglobin content in serum,reduce the risk and degree of jaundice in premature infant,with better safety.

Objective:To establish and verify a model to predict histologic chorioamnionitis (HCA) for women during expected management of preterm premature rupture of membranes (PPROM) at 24-34 weeks of gestation.Methods:This retrospective study enrolled 493 pregnant women who were diagnosed with PPROM at 24-33 +6 weeks of gestation and delivered in Peking University Third Hospital from January 1, 2012, to December 31, 2020. They were randomly divided into the modeling set ( n=345) and validation set ( n=148) at a ratio of 7∶3. Basic information, risk factors, clinical treatment, and maternal and infant outcomes were compared between participants with and without HCA using Chi-square test, t test, or Mann-Whitney U test. Multivariate logistic regression analysis was performed to analyze the independent risk factors for HCA. The predictive values of different indexes for HCA were compared and the predictive model was then established and verified using the receiver operating characteristic (ROC) curve and area under curve (AUC). Results:There were no significant differences in the basic information, common risk factors for premature rupture of membranes (PROM), or the use of tocolytics, antibiotics or dexamethasone between women in the HCA and non-HCA groups (all P>0.05). Compared with the non-HCA group, the HCA group showed an earlier onset of PROM [31.3 (24.0-33.9) vs 32.3 (27.0-33.9) gestational weeks, U=4 103.00, P=0.017], longer expected treatment [66.5 (0.7-895.3) vs 18.0 (0.3-1 123.0) h, U=1 791.00, P<0.001] and higher incidence of neonatal asphyxia, sepsis, and intracranial hemorrhage [24.3% (58/239) vs 13.2% (14/106), χ 2=5.44; 9.6% (23/239) vs 2.8% (3/106), χ 2=4.86; 41.0% (98/239) vs 17.9% (19/106), χ 2=17.45; all P<0.05]. Moreover, the positive rate of bacterial culture, C-reactive protein (CRP) level, neutrophil/lymphocyte ratio (NLR), white blood cell (WBC) and neutrophil counts were significantly increased in the HCA group [37.2% (89/239) vs 22.6% (24/106), χ 2=7.10; 8.2 (0.0-273.0) vs 5.0 (0.0-218.9) ng/ml, U=2 419.00; 5.6 (1.2-58.6) vs 4.6 (1.7-18.7), U=2 357.50; 11.9 (4.5-30.0)×10 9/L vs 10.1 (5.8-21.8)×10 9/L, U=4 074.50; 9.5 (2.5-28.1)×10 9/L vs 7.6 (3.5-18.5)×10 9/L, U=4 021.50; all P<0.05], while the lymphocyte count was decreased [1.5 (0.5-3.7)×10 9/L vs 1.6 (0.7-3.9)×10 9/L, U=4 237.00, P=0.017]. CRP level, NLR, the gestational week at the onset of PROM and the duration of expected treatment were independent risk factors for HCA ( OR=1.069, 95% CI: 1.024-1.117; OR=1.192, 95% CI: 1.048-1.356; OR=0.906, 95% CI: 0.867-0.947; OR=1.017, 95% CI: 1.007-1.026). Based on the four risk factors, the predictive model was established and ROC curve was drawn. AUC for evaluating the performance of the predictive model was 0.880, which indicated a clinical significance. Conclusion:The model established based on the four risk factors, which were CRP level, NLR, the gestational week at onset of PROM and the duration of expected treatment, performs well in the prediction of HCA in women with PPROM during expected treatment and has good clinical practical value.

Objective To explore the the characteristics of non-motor symptoms of essential tremor(ET).Methods Totally 50 ET patients and 45 age-gender-matched healthy volunteers,admitted in Department of Neurology,The Second Affiliated Hospital of Zhejiang University School of Medicine from May 2015 to April 2016,were included.Clinical data and tremor analyses under different postures were obtained.The non-motor symptoms were evaluated using the Pittsburgh Sleep Quality Index(PSQI),Hamilton anxiety scale(HAMA),Hamilton's Depression Scale(HAMD),and the MOS item short from health survey (SF-36).Cognitive functions were evaluated by the Minimental state examination(MMSE).Results ET group had lower MMSE total score of (25.81 ±2.75 vs.28.16 ± 1.71),increased rate of dyssomnia (62.0％ vs.15.6％) and higher PQSI score (6.42±2.71 vs.3.84±2.13)compared with the control group(all P＜0.05).Moreover,more patients in the ET group had moderate and severe anxiety(60.0 ％ vs.37.8 ％),moderate and severe depression (34.0％ vs.15.6％)than the control group(both P ＜ 0.05).Anxiety and depression had effects on physical and mental health and were also related to the quality of life.Conclusions Non-motor symptoms,such as mild cognitive deficits,depression,anxiety and dyssomnia are common in ET patients.Furthermore,depression and anxiety have negative effects on physical and mental health.

BACKGROUND:Prosthesis loosening and wear are still the main problems in the failure of total ankle replacement,which are closely related to the micro-motion of the implant-bone interface,the contact stress of the articular surface and joint motion.The design of artificial joint components,including insert and tibial/talar stem prosthesis,is a key factor affecting the force,motion,and micromotion of the contact interface of the ankle joint.The development of new inserts is of great significance to improve the survival rate of artificial ankle joints. OBJECTIVE:The finite element model of the total ankle replacement model was constructed to detect the biomechanical properties of the porous structure-optimized inserts,and the effect of the porous structure-optimized inserts on reducing prosthesis micromotion and improving the contact behavior of the articular surface was analyzed. METHODS:Based on the CT scan data of the right ankle joint of a healthy adult and the INBONE Ⅱ system product manual,a three-dimensional model including bone and artificial joint system was established,and the total ankle replacement model(model A)was obtained after osteotomy and prosthesis installation,and then through four new types of inserts,G50,G60,D50,and D60,were obtained by transforming the porous structure of the original insert,and the original one was replaced with different inserts to establish an optimized total ankle replacement model(models B-E)corresponding to the inserts.The gait loads were applied on the five models to simulate the gait conditions.The differences in micromotion and articular surface contact behaviors at the implant-bone interface of all five models were compared. RESULTS AND CONCLUSION:(1)In the gait cycle,the micromotion of the prosthesis of the four optimized total ankle replacement models was lower than that of the original model.Compared with model A,the micromotion of the prosthesis in models B-E decreased by 5.4%,10.1%,8.1%,and 20.9%,respectively.The high micromotion area of t ??he tibial groove dome in the optimized model was significantly smaller than that of the original model.(2)The four optimized models obtained a larger articular surface contact area.Compared with model A,the average contact area of t ??he inserts in models B-E increased by 11.8%,14.7%,8.1%,and 32.6%,respectively.(3)Similar to the effect of increasing the contact area,compared with the original model,the contact stress of the optimized model decreased in varying degrees,and the value of model E decreased the most significantly(P<0.05),it is due to good mechanical properties and large porosity of the Diamond lattice that constitutes the D60-type insert.(4)The research results show that the use of porous structure to improve the inserts can improve the elasticity of the inserts and increase its ability to absorb joint impact,for favorable conditions are created for reducing micromotion at the implant-bone interface and improving joint contact behavior.