BACKGROUND:The timing of tourniquet application in traditional total knee arthroplasty has been clearly reported.With the continuous refinement of joint-related techniques,the timing of tourniquet application in total knee arthroplasty under navigation system has rarely been reported.OBJECTIVE:To evaluate the effect of total knee arthroplasty with Brainlab navigation system using full-course and half-course tourniquets.METHODS:From January to December 2022,data of 145 eligible patients who underwent total knee arthroplasty under navigation system in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were retrospectively analyzed and they were divided into the full course group(n=71)and the half course group(n=74)according to the timing of tourniquet release.General data,perioperative conditions,postoperative swelling around the knee joint,postoperative lower extremity deep venous thrombosis,visual analog scale score,Hospital for Special Surgery knee score,and forgotten joint score were collected to assess knee joint function and statistically compared.RESULTS AND CONCLUSION:(1)The operation time of the full course group was shorter than that of the half course group,the incidence of lower extremity deep venous thrombosis was higher,and the postoperative knee joint swelling was more severe(P＜0.001,P=0.027,P＜0.001).The intraoperative blood loss of the full course group was less than that of the half course group(P＜0.001),and the occult blood loss of the full course group was more than that of the half course group(P＜0.001),with statistically significant differences.(2)At 1 week after surgery,the visual analog scale score in the full course group was significantly higher than that in the half course group(P＜0.001).(3)There was no significant difference in forgotten joint score between the two groups at 3,6 months and 1 year after surgery(P＞0.05).(4)It is indicated that in patients undergoing total knee arthroplasty using a navigation system,the half-course group has less occult blood loss,lower postoperative swelling and incidence of postoperative lower extremity deep venous thrombosis,and faster recovery of knee joint function.

Objective:To investigate the clinical results of anteriorly displaced orbicularis oculi flap and autologous granular fat injections via sub-brow incision for correction of different degrees of sunken upper eyelid.Methods:From September 2021 to September 2022, a total of 80 patients with upper eyelid skin laxity and sunken upper eyelid were recruited prospectively from the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine. There were 18 males and 62 females, aged 28 to 60 years, with a mean age of (42.7±9.2) years. According to Park's method, 59 patients with grade Ⅰ and grade Ⅱ sunken upper eyelid were treated with eyebrow lifting and orbicularis oculi flap correction, and 21 patients with grade Ⅲ upper eyelid sunken were treated with eyebrow lifting combined with autologous particles fat filling. The patients were followed up for 6 months. The depth of sunken upper eyelid was measured before and after operation. The incidence of adverse reactions and patient satisfaction were recorded.Results:The mean depth of depression measured preoperatively was (6.01±2.25) mm in the grades Ⅰ and Ⅱ sunken upper eyelid, which was improved to (2.00±1.06) mm at the 6-month postoperative follow-up ( P=0.001), and the mean depth of depression was (13.15±1.75) mm in the group of grade Ⅲ, which was improved to (4.15±1.49) mm at the 6-month postoperative follow-up ( P=0.001). After 6-month follow-up, the incidence of complications was 6.3% (5/80) and the satisfaction rate was 90.0% (72/80). Conclusions:Different correction methods should be chosen according to the degree of sunken upper eyelid. Grades Ⅰand Ⅱ sunken upper eyelid are corrected with orbicularis muscle flap through sub-eyebrow incision, and grade Ⅲ is corrected with autologous fat injection. Both the clinical effect and patient satisfaction rate are higher.

OBJECTIVE To evaluate the current status of bacterial contamination control and prevention measures and construction of quality control laboratory in Chinese blood station,and find out the problems and put forward the improvement suggestions.METHODS A total of 41 questionnaires were sent out for performance comparison by secretariat of working group of Chinese blood collection and supply institutions from May 2024 to Jun.2024,and 40 questionnaires were received(14 blood centers and 26 central blood stations),39 of which were valid.The questionnaire survey covered four aspects,including disinfection and surveillance,construction of quality control laboratory,sterility test for blood component and monitoring of blood transfusion reactions.The data were pro-cessed through itemized statistics and descriptive analysis.RESULTS Totally 84.62％of the blood stations used io-dine-containing disinfectants for arm disinfection of the blood donors,and the monthly monitoring was the primary frequency.Among the quality control laboratories,43.59％were registered as biosafety level 2,while 35.90％lacked biosafety registration.As for the pressure settings of the laboratories,64.10％were under normal pres-sure,15.38％under negative pressure and 17.95％under positive pressure.In the sterility test,the utilization rate of ultra clean operating tables and biological safety cabinets was 48.72％,the blood stations that did not have the indoor quality control accounted for 79.49％,and only 35.90％participated the external quality assessment.Regarding the approaches to confirm the positive result,25.64％of the blood stations adopted the re-peated tests,and 15.38％adopted the combination with positive culture bottle.The shortage of fund was the ma-jor restricted factor for the sterility test,and the confirmation of positive result was the fundamental difficulty.The blood stations with the feedback of insufficient transfusion reactions reported from hospitals ac-counted for 53.85％,while the blood stations that encountered suspected bacterial transfusion reactions with nega-tive culture results accounted for 25.64％.CONCLUSIONS The infeciton control and prevention measures and the construction of quality control laboratory vary significantly in Chinese blood stations.The incomplete biosafety registration,non-standardized sterility test operation and weak surveillance of blood transfusion reactions are the major existing problems.It is suggested that the investment should be increased to push forward the standardi-zation and complete the laboratory biosafety system,and a hospital-blood station closed loop coordination mecha-nism should be established so as to raise the blood safety.

OBJECTIVE To evaluate the current status of bacterial contamination control and prevention measures and construction of quality control laboratory in Chinese blood station,and find out the problems and put forward the improvement suggestions.METHODS A total of 41 questionnaires were sent out for performance comparison by secretariat of working group of Chinese blood collection and supply institutions from May 2024 to Jun.2024,and 40 questionnaires were received(14 blood centers and 26 central blood stations),39 of which were valid.The questionnaire survey covered four aspects,including disinfection and surveillance,construction of quality control laboratory,sterility test for blood component and monitoring of blood transfusion reactions.The data were pro-cessed through itemized statistics and descriptive analysis.RESULTS Totally 84.62％of the blood stations used io-dine-containing disinfectants for arm disinfection of the blood donors,and the monthly monitoring was the primary frequency.Among the quality control laboratories,43.59％were registered as biosafety level 2,while 35.90％lacked biosafety registration.As for the pressure settings of the laboratories,64.10％were under normal pres-sure,15.38％under negative pressure and 17.95％under positive pressure.In the sterility test,the utilization rate of ultra clean operating tables and biological safety cabinets was 48.72％,the blood stations that did not have the indoor quality control accounted for 79.49％,and only 35.90％participated the external quality assessment.Regarding the approaches to confirm the positive result,25.64％of the blood stations adopted the re-peated tests,and 15.38％adopted the combination with positive culture bottle.The shortage of fund was the ma-jor restricted factor for the sterility test,and the confirmation of positive result was the fundamental difficulty.The blood stations with the feedback of insufficient transfusion reactions reported from hospitals ac-counted for 53.85％,while the blood stations that encountered suspected bacterial transfusion reactions with nega-tive culture results accounted for 25.64％.CONCLUSIONS The infeciton control and prevention measures and the construction of quality control laboratory vary significantly in Chinese blood stations.The incomplete biosafety registration,non-standardized sterility test operation and weak surveillance of blood transfusion reactions are the major existing problems.It is suggested that the investment should be increased to push forward the standardi-zation and complete the laboratory biosafety system,and a hospital-blood station closed loop coordination mecha-nism should be established so as to raise the blood safety.

BACKGROUND:The timing of tourniquet application in traditional total knee arthroplasty has been clearly reported.With the continuous refinement of joint-related techniques,the timing of tourniquet application in total knee arthroplasty under navigation system has rarely been reported.OBJECTIVE:To evaluate the effect of total knee arthroplasty with Brainlab navigation system using full-course and half-course tourniquets.METHODS:From January to December 2022,data of 145 eligible patients who underwent total knee arthroplasty under navigation system in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were retrospectively analyzed and they were divided into the full course group(n=71)and the half course group(n=74)according to the timing of tourniquet release.General data,perioperative conditions,postoperative swelling around the knee joint,postoperative lower extremity deep venous thrombosis,visual analog scale score,Hospital for Special Surgery knee score,and forgotten joint score were collected to assess knee joint function and statistically compared.RESULTS AND CONCLUSION:(1)The operation time of the full course group was shorter than that of the half course group,the incidence of lower extremity deep venous thrombosis was higher,and the postoperative knee joint swelling was more severe(P＜0.001,P=0.027,P＜0.001).The intraoperative blood loss of the full course group was less than that of the half course group(P＜0.001),and the occult blood loss of the full course group was more than that of the half course group(P＜0.001),with statistically significant differences.(2)At 1 week after surgery,the visual analog scale score in the full course group was significantly higher than that in the half course group(P＜0.001).(3)There was no significant difference in forgotten joint score between the two groups at 3,6 months and 1 year after surgery(P＞0.05).(4)It is indicated that in patients undergoing total knee arthroplasty using a navigation system,the half-course group has less occult blood loss,lower postoperative swelling and incidence of postoperative lower extremity deep venous thrombosis,and faster recovery of knee joint function.

Objective:To investigate the clinical results of anteriorly displaced orbicularis oculi flap and autologous granular fat injections via sub-brow incision for correction of different degrees of sunken upper eyelid.Methods:From September 2021 to September 2022, a total of 80 patients with upper eyelid skin laxity and sunken upper eyelid were recruited prospectively from the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine. There were 18 males and 62 females, aged 28 to 60 years, with a mean age of (42.7±9.2) years. According to Park's method, 59 patients with grade Ⅰ and grade Ⅱ sunken upper eyelid were treated with eyebrow lifting and orbicularis oculi flap correction, and 21 patients with grade Ⅲ upper eyelid sunken were treated with eyebrow lifting combined with autologous particles fat filling. The patients were followed up for 6 months. The depth of sunken upper eyelid was measured before and after operation. The incidence of adverse reactions and patient satisfaction were recorded.Results:The mean depth of depression measured preoperatively was (6.01±2.25) mm in the grades Ⅰ and Ⅱ sunken upper eyelid, which was improved to (2.00±1.06) mm at the 6-month postoperative follow-up ( P=0.001), and the mean depth of depression was (13.15±1.75) mm in the group of grade Ⅲ, which was improved to (4.15±1.49) mm at the 6-month postoperative follow-up ( P=0.001). After 6-month follow-up, the incidence of complications was 6.3% (5/80) and the satisfaction rate was 90.0% (72/80). Conclusions:Different correction methods should be chosen according to the degree of sunken upper eyelid. Grades Ⅰand Ⅱ sunken upper eyelid are corrected with orbicularis muscle flap through sub-eyebrow incision, and grade Ⅲ is corrected with autologous fat injection. Both the clinical effect and patient satisfaction rate are higher.

【Objective】 To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique. 【Methods】 Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror; Φ1.8 mm soft grasper, tissue scissors, electric hook, and ultrasonic scalpel were used as instruments; the porcine bladder was used as a model.The PORT was placed through the urethra, and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity, the soft grasper was inserted to pull the mucosa to be removed, which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand, and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper, the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa. 【Results】 The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models. 【Conclusion】 The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors, and has the potential of clinical application after further optimization.

Objective:To investigate the consistency between the iodine-unstained area and the pathological size of endoscopic submucosal dissection (ESD) specimens of superficial esophageal cancer.Methods:A retrospective study was performed on data of 32 patients with superficial esophageal cancer who accepted ESD from May 2019 to April 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The maximum transverse diameter and maximum longitudinal diameter of the iodine-unstained area were compared with the tumor pathological area. A size difference no more than 0.5 cm was considered as conformity, any difference between 0.5 and 1.0 cm was considered as non-conformity, and any difference no less than 1.0 cm was considered as serious non-conformity. At the same time, pink sign after spraying Lugo solution and the consistency of pink sign area with the iodine free area were observed.Results:A total of 32 patients with 33 lesions were enrolled in this study, including 23 males and 9 females and the age of the patients was 59.5±7.3 years. There were 19 (57.6%) lesions whose size of iodine-unstained area was consistent with the tumor pathological area. These 19 lesions were all positive for the pink sign, and the pink sign area overlapped with the iodine-unstained area. In addition, 4 (12.1%) iodine-unstained areas of the lesions did not match the size of the pathological area, and 10 (30.3%) iodine-unstained areas of the lesions were seriously inconsistent with the size of the pathological area. These 14 (42.4%) lesions were all positive for pink sign, and the pink sign area was significantly smaller than the iodine-unstained area. Among the 14 discordant lesions, 2 lesions underwent ESD according to the iodine-unstained area, which resulted in excessive resection and postoperative stenosis.Conclusion:Determining the extent of superficial esophageal cancer by iodine-unstained areas before ESD may lead to excessive resection of the lesions, which is related to the fact that the iodine-unstained areas of the lesions are sometimes significantly larger than the pink sign areas. Therefore, in order to achieve precise treatment, endoscopists can choose the iodine-unstained area with positive pink sign as the first choice for resection.

Objective:To summarize the clinical characteristics of pancreatic solid pseudopapillary neoplasm (pSPN).Methods:From March 2007 to August 2022, at the First Affiliated Hospital of Zhejiang University School of Medicine, the clinical data and follow-up results of 253 patients with pSPN and underwent surgical treatment were retrospectively analyzed. The diagnostic accuracy of preoperative ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and puncture biopsy of aspiration were compared and analyzed. Kaplan-Meier method was performed to calculate disease-free survival rate. The gender differences in the clinical and pathological features of pSPN were compared. According to whether recurrence and metastasis occurred after the primary operation, the patients with pSPN were divided into recurrence and metastasis group ( n=3) and disease-free survival group ( n=250). Univariate analysis was used to analyze whether gender, age, married status, with clinical symptoms, history of alcohol drinking or smoking, puncture biopsy of aspiration before operation, location and maximum diameter of tumor, surgical method (open surgery, minimally invasive surgery), type of surgery (parenchymal preservation surgery, conventional surgery), and pathological features (cellular atypia, invasion of adjacent organs, lymphovascular invasion, peripancreatic fat invasion, perineural invasion, capsular invasion and pancreatic parenchyma invasion) were predictive factors of recurrence and metastasis of pSPN. Two independent sample t test, chi-square test and Fisher′s exact test were used for statistical analysis. Results:Among 253 patients with pSPN, 49 (19.4%) were males and 204 (80.6%) were females. The diagnostic accuracy of MRI and CT were both higher than that of ultrasound (73.4%(124/169), 64.0%(146/228) vs. 33.3%(78/234)), and the diagnostic accuracy of MRI was higher than that of CT, and the differences were statistically significant ( χ2=62.93, 43.58 and 3.89, P<0.001, <0.001 and =0.049). The diagnostic accuracy of puncture biopsy of aspiration combined with immunochemistry was higher than that without combined immunochemistry (100.0%(23/23) vs. 8/13), and the difference was statistically significant (Fisher′s exact test, P=0.003). Eight cases missed during follow-up, and all the other 245 patients survived with the 5- year and 10-year disease-free survival rates of 99.2% and 97.2%, respectively. Male pSPN patients were older than female patients at diagnosis ((40.0±13.2) years old vs. (32.6±11.9) years old) and the maximum diameter of tumor was smaller than that of female patients ((3.88±2.05) cm vs. (4.87±3.05) cm), and the differences were statistically significant ( t=3.83 and -2.15, P<0.001 and =0.032). The results of univariate analysis showed that lymphovascular invasion was significantly correlated with pSPN recurrence and metastasis (Fisher′s exact test, P=0.012), and the other factors were not correlated with pSPN recurrence and metastasis (all P>0.05). Conclusions:CT, MRI and puncture biopsy of aspiration are comparatively reliable diagnostic method for pSPN before operation. There are significant differences in pSPN tumor growth and age of onset between genders. The postoperative recurrent rate of pSPN is low and the prognosis is good. Even if recurrence and metastasis occur, the patients can still survive for a long time after surgical treatment.

The amygdala is an important hub for regulating emotions and is involved in the pathophysiology of many mental diseases, such as depression and anxiety. Meanwhile, the endocannabinoid system plays a crucial role in regulating emotions and mainly functions through the cannabinoid type-1 receptor (CB₁R), which is strongly expressed in the amygdala of non-human primates (NHPs). However, it remains largely unknown how the CB₁Rs in the amygdala of NHPs regulate mental diseases. Here, we investigated the role of CB₁R by knocking down the cannabinoid receptor 1 (CNR1) gene encoding CB₁R in the amygdala of adult marmosets through regional delivery of AAV-SaCas9-gRNA. We found that CB₁R knockdown in the amygdala induced anxiety-like behaviors, including disrupted night sleep, agitated psychomotor activity in new environments, and reduced social desire. Moreover, marmosets with CB₁R-knockdown had up-regulated plasma cortisol levels. These results indicate that the knockdown of CB₁Rs in the amygdala induces anxiety-like behaviors in marmosets, and this may be the mechanism underlying the regulation of anxiety by CB₁Rs in the amygdala of NHPs.
Animals ; Callithrix ; Receptors, Cannabinoid ; Anxiety ; Amygdala ; Cannabinoids ; Phenotype