AIM: To analyze the recovery of stereopsis and its influencing factors in children with intermittent exotropia(IXT)after binocular vision training.METHODS: A total of 166 cases of IXT children who were treated in our hospital from October 2021 to October 2023(2 cases lost their follow-up, and 164 cases were finally included)were included as the research object, taking 36 cases with no stereopsis after binocular vision training in eye position correction surgery as no stereopsis group, and other 128 cases as stereopsis group. All the children underwent eye position correction surgery under general anesthesia, and all received binocular vision training for 6 mo after surgery. The recovery of stereoscopic vision of IXT children after binocular vision training was counted, and the influencing factors of stereoscopic vision recovery of IXT children after binocular vision training were analyzed by single factor and multi-factor Logistic regression analysis.RESULTS: The incidence of postoperative no stereopsis was 22.0%. The proportion of children with an age ≥9 years old, course of disease ≥1 a and anisometropia in the group without stereoscopic vision after operation was larger than the group with stereoscopic vision(all P<0.05). Multivariate Logistic regression analysis showed that the course of disease ≥1 a, age ≥9 years old and anisometropia were independent influencing factors for the recovery of stereoscopic vision in IXT children after binocular vision training(OR=1.470, 1.626, 1.539, all P<0.05).CONCLUSION: Age ≥9 years old, course of disease ≥1 a, and anisometropia are the independent influencing factors of stereopsis recovery of IXT children after binocular vision training. Therefore, targeted intervention measures can be given to high-risk children to improve the stereopsis recovery of IXT children after binocular vision training.

OBJECTIVE: To observe the effect of acupuncture on chondrocyte autophagy in rats of knee osteoarthritis (KOA) and explore its underlying mechanisms. METHODS: Forty male SPF-grade SD rats were randomized into a blank group, a model group, a suspension group, an acupuncture group, and a combined therapy group, 8 rats in each one. Except the blank group, KOA model was prepared by the injection with papain. The suspension exercise therapy (10 min each time, three times daily), acupuncture (at "Yanglingquan" [GB34], "Zusanli" [ST36], and "Dubi" [ST35] on the right side, 30 min each intervention, once daily) and the combined therapy (the suspension exercise therapy combined with acupuncture) were delivered in the suspension group, the acupuncture group and the combined therapy group, respectively. The intervention of each group was performed continuously for 6 days, and 4 consecutive weeks, at the interval of 1 day. Before and after intervention, Lequesne MG score was assessed in the rats. After intervention, HE staining was adopted to observe the cartilaginous tissue morphology of the right knee joints, and Mankin score was evaluated; the serum levels of interleukin (IL)-1β, IL-6, and tumor neurosis factor-α (TNF-α) were measured using ELISA; the real-time PCR was provided to determine the mRNA expression of collagen protein type Ⅱ(COL2), collagen protein type Ⅹ (COL10), phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt), mammalian target of rapamycin (mTOR), and autophagy-regulated protein (Beclin-1) in the cartilaginous tissue of the right knee joint; Western blot was employed to detect the protein expression of PI3K, phosphorylated PI3K (p-PI3K), Akt, phosphorylated Akt (p-Akt), mTOR, phosphorylated mTOR (p-mTOR) and Beclin-1 in the cartilaginous tissue of the right knee joint. RESULTS: Compared with the blank group, the rats in the model group showed the higher Lequesne MG score (P<0.01), thinner cartilage of the right knee, reduced chondrocytes and disordered arrangement, and higher Mankin score (P<0.01). Besides, in the model group, the serum levels of IL-1β, IL-6 and TNF-α were elevated (P<0.01), the mRNA expression of COL2 and Beclin-1 and the protein expression of Beclin-1 decreased (P<0.01), the mRNA expression of COL10, PI3K, Akt and mTOR, and the protein expression of p-PI3K, p-Akt and p-mTOR increased (P<0.01) in the cartilaginous tissue of the right knee joint. Compared with the model group, in the suspension group, the acupuncture group and the combined therapy group, the Lequesne MG scores were reduced (P<0.01), the cartilage of the right knee was thickened, the arrangement of chondrocytes was improved, and the Mankin scores were lower (P<0.01). Besides, in these intervention groups, the serum levels of IL-1β, IL-6 and TNF-α were reduced (P<0.01), the mRNA expression of COL2 and Beclin-1 and the protein expression of Beclin-1 increased (P<0.05, P<0.01), the mRNA expression of COL10, PI3K, Akt and mTOR, and the protein expression of p-PI3K, p-Akt and p-mTOR decreased (P<0.05, P<0.01) in the cartilaginous tissue of the right knee joint. When compared with the suspension group and the acupuncture group, in the combined therapy group, the Lequesne MG score was reduced (P<0.01), and the Mankin score was reduced (P<0.05, P<0.01). Besides, the serum levels of IL-1β, IL-6 and TNF-α were reduced (P<0.05), the mRNA expression of COL2 and Beclin-1 and the protein expression of Beclin-1 increased (P<0.05), the mRNA expression of COL10, PI3K, Akt and mTOR, and the protein expression of p-PI3K, p-Akt and p-mTOR decreased (P<0.05, P<0.01) in the cartilaginous tissue of the right knee joint. CONCLUSION Acupuncture can promote cartilage regeneration of knee joint and autophagy in KOA rats, alleviate inflammation, so as to retard cartilage degeneration, which may be possibly associated with the PI3K/Akt/mTOR signaling pathway.
Animals ; Male ; Acupuncture Therapy ; Proto-Oncogene Proteins c-akt/genetics* ; TOR Serine-Threonine Kinases/genetics* ; Osteoarthritis, Knee/physiopathology* ; Phosphatidylinositol 3-Kinases/genetics* ; Rats ; Signal Transduction ; Rats, Sprague-Dawley ; Chondrocytes/metabolism* ; Humans ; Autophagy ; Acupuncture Points

OBJECTIVE: To review the main fixation methods for proximal tibial extra-articular fractures based on clinical and biomechanical results, and to provide evidence for clinical application. METHODS: Extensive related literature at home and abroad was conducted in recent years, and external fixation systems such as external fixation braces and external locking plates, as well as internal fixation systems such as plates and intramedullary nails, were systematically reviewed regarding their application indications, clinical efficacy, and biomechanical results in proximal tibial extra-articular fractures. RESULTS: External fixation systems have advantages in fractures with open or severe soft tissue injury, facilitating wound management and maintaining stability of the fracture site to some extent. However, in proximal tibial extra-articular fractures with good soft tissue conditions, internal fixation systems such as plates and intramedullary nails are still the first choice. Some studies have found that intramedullary nails allow patients to bear weight early, with shorter fracture healing time and higher rate of malunion, while other studies have found that both intramedullary nails and plates have similar clinical efficacy and can achieve satisfactory treatment results. CONCLUSION The choice of fixation method for proximal tibial extra-articular fractures depends not only on the type of fracture, but also on the surgeon's habits and operational skills. Larger-scale studies are still needed to clarify the advantages and disadvantages of intramedullary nails and locking plates in the treatment of proximal tibial extra-articular fractures.
Humans ; Tibial Fractures/surgery* ; Bone Plates ; Fracture Fixation, Intramedullary/instrumentation* ; Fracture Fixation, Internal/instrumentation* ; Fracture Healing ; External Fixators ; Bone Nails ; Fracture Fixation/instrumentation* ; Treatment Outcome ; Biomechanical Phenomena

Objective:To compare the analgesic effects of sufentanil patient-controlled intravenous analgesia(PCIA)and liposomal bupivacaine incision local infiltration anesthesia(LIA)in the elderly patients undergoing single-or double-segment posterior lumbar surgery,and to provide the basis for selecting postoperative analgesia methods in the elderly patients undergoing lumbar surgery.Methods:A total of 124 elderly patients in our hospital scheduled for elective single-or double-segment posterior lumbar surgery under general anesthesia were selected and divided into sufentanil PCIA group(PCIA group)and liposomal bupivacaine incision LIA group(LIA group)in a 1∶1 ratio,with 62 patients in each group.After excluding those who withdrew from the trial midway,58 patients were finally included in PCIA group and 60 in LIA group.Thirty minutes before the end of surgery,the patients in PCIA group were treated with a analgesia pump regimen of sufentanil 1.5 μg·kg-1 combined with dexmedetomidine 1.5 μg·kg-1.At the end of surgery,the patients in LIA group received multi-point bilateral injections along the surgical incision by a spine surgeon using liposomal bupivacaine 266 mg(diluted in 40 mL of saline).The resting visual analog scale(VAS)pain scores(non-inferiority margin δ=10 mm)at 30 min,6 h,24 h,48 h,and 72 h postoperatively,the incidences of postoperative adverse reactions(such as nausea and vomiting,respiratory depression,pruritus,constipation,dizziness and drowsiness),the number of postoperative rescue analgesia interventions,anesthesia satisfaction scores at 48 and 72 h postoperatively,postoperative hospital stay,and wound healing status at discharge were recorded.Results:From 30 min to 48 h postoperatively,the resting VAS pain scores of the patients in LIA group were higher than those in PCIA group(P＜0.001),while the resting VAS pain scores at 72 h postoperatively in LIA group were lower than those in PCIA group(P＜0.001).At 30 min,24 h,and 48 h postoperatively,non-inferiority was established,indicating that the analgesic effect of liposomal bupivacaine incision LIA was not inferior to that of sufentanil PCIA.At 6 h postoperatively,non-inferiority was not established.At 72 h postoperatively,the analgesic effect of liposomal bupivacaine incision LIA was superior to that of sufentanil PCIA(P＜0.001).Compared with PCIA group,the incidence of postoperative nausea and vomiting of the patients in LIA group was decreased(P＜0.05).There were no significant differences in the incidences of postoperative dizziness and drowsiness,constipation,respiratory depression,and pruritus between two groups(P＞0.05).Compared with PCIA group,the postoperative hospital stay of the patients in LIA group was shortened(P＜0.001).There were no significant differences in the number of postoperative rescue analgesia interventions or wound healing grade between two groups(P＞0.05).The anesthesia satisfaction scores of the patients in LIA group at 48 and 72 h postoperatively were higher than those in PCIA group(P＜0.05).Conclusion:In the elderly patients undergoing single-or double-segment lumbar surgery,the analgesic effect of liposomal bupivacaine incision LIA is not inferior to that of sufentanil PCIA,with a lower incidence of postoperative adverse reactions and higher postoperative analgesia satisfaction scores.

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

【Objective】 To explore the application of machine learning in scientific and rational blood preparation and predictive analysis for surgical blood usage before liver transplantation surgery. 【Methods】 Clinical basic information including gender, age, clinical diagnosis and surgical methods of 356 liver transplantation patients were collected. The duration (Time) and preoperative laboratory test results of hemoglobin (Hb), hematocrit (Hct), platelet count (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), total bilirubin (TBIL), albumin (ALB), creatinine (Crea) and total protein (TP), as well as the amount of intraoperative blood transfusion were collected. A machine learning model capable of predicting the risk of massive blood transfusion during liver transplantation surgery was established by Python, and was evaluated to select the optimal predictive model. 【Results】 Among the 7 machine learning models constructed, the logistic regression model performed the best (AUROC: 0.90, F1 score: 0.82), with an accuracy of 79.44% and precision of 79.69%, followed by the random forest classifier (AUROC: 0.87, F1 score: 0.83), with an accuracy of 79.44% and precision of 77.94%. 【Conclusion】 Establishing a machine learning prediction model by Python is of significant clinical importance for scientific blood preparation, predicting the risk of massive blood transfusion and ensuring the safety of blood use in liver transplantation surgery.

Objective:To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy.Methods:A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T 0 (baseline period), T 1 (after anesthesia induction), T 2 (colonoscopy over sigmoid colon), T 3 (colonoscopy over the liver region), T 4 (after the end of examination), and T 5 (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert′s four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. Results:The general data at baseline were not statistically different between the two groups ( P>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C ( P=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C ( P<0.05), and intraoperative norepinephrine use was also lower than in the group C ( P=0.034). Postoperative visual analog scale pain scores were lower in group G ( P=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth ( P=0.035). Conclusion:During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.

Objective:To evaluate the safety and efficacy of the domestic robotic surgical system for general surgery.Methods:A prospective single-center, single-arm exploratory study was conducted at Gansu Provincial People's Hospital from Jun 2022 to Oct 2023, enrolling 54 patients undergoing general surgery using domestically produced Toumai? Endoscopic Surgical Robotic System. The primary study endpoint was surgical success rate, and the secondary study endpoints were intraoperative bleeding, operative time, complications, system performance, hospitalization days.Results:In this study, robotic surgery was successfully completed in 52 patients, and in 2 patients undergoing thyroid operation it was converted to open surgery due to bleeding, with a success rate of 96%, no organ injury or death during surgery, and no system failure. The types of surgery included cholecystectomy, radical gastric cancer resection, radical colorectal cancer resection, inguinal hernia repair, partial hepatectomy, total thyroidectomy and choledocho-jejunal anastomosis.Conclusion:The study provides preliminary evidence of the safety and efficacy of the Toumai? Endoscopic Surgical Robotic System for the treatment of general surgical diseases.

Objective To observe the value of 3D Res2Net deep learning model for predicting volume doubling time(VDT)of solid pulmonary nodule.Methods Chest CT data of 734 patients with solid pulmonary nodules were retrospectively analyzed.The patients were divided into progressive group(n=218)and non-progressive group(n=516)according to whether lung nodule volume increased by ≥25％during follow-up or not,also assigned into training set(n=515)and validation set(n=219)at a ratio of 7∶3.Then a clinical model was constructed based on clinical factors being significantly different between groups,CT features model was constructed based on features of nodules on 2D CT images using convolutional neural network,and 3D Res2Net model was constructed based on Res2Net network using 3D CT images as input.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated.Taken actual VDT as gold standard,the efficacy of the above models for predicting solid pulmonary nodule'VDT≤400 days were evaluated.Results No significant difference of predicting efficacy for solid pulmonary nodule'VDT≤400 days was found among clinical model,CT feature model and 3D Res2Net model,the AUC of which was 0.689,0.698 and 0.734 in training set,0.692,0.714 and 0.721 in validation set,respectively.3D Res2Net model needed 5-7 s to predict VDT of solid pulmonary nodules,with an average time of(5.92±1.08)s.Conclusion 3D Res2Net model could be used to predict VDT of solid pulmonary nodules,which might obviously reduce manual interpreting time.