Objective To evaluate clinical effect of remote ischemic conditioning(RIC)in patients with spontaneous intracerebral hemorrhage(sICH).Methods Sixty-four patients with sICH who were diagnosed and admitted to the Department of Neurosurgery,the Sixth Medical Center of PLA General Hospital from January 2023 to May 2024 were selected as research subjects.Following the principle of matching baseline characteristics between groups,a computerized random grouping program was used to divide them into an observation group of 32 cases and a control group of 32 cases.Patients in the control group received standard basic medication according to the'Chinese Clinical Management Guidelines for Cerebrovascular Diseases',while the observation group received RIC treatment in addition to the control group's treatment,with a course of 14 d.The changes in National Institutes of Health Stroke Scale(NIHSS)scores and Barthel index(BI,daily living ability score table)on the day of admission and after 14 d of treatment,the changes in hematoma volume on computed tomography(CT)imaging,and the incidence of adverse events were compared between the two groups.Results At admission,the difference is not statistically significant in NIHSS scores,BI,and CT imaging hematoma volume between the two groups(P>0.05).After 14 d of treatment,the NIHSS scores of both groups were reduced compared to before treatment,and the scores of the observation group were lower than those of the control group(P<0.05);the BI of both groups was increased compared to before,and the scores of the observation group were higher than those of the control group(P<0.05);there were no significant differences in CT imaging hematoma volume and the incidence of adverse events between the two groups(P>0.05).Conclusion Continuous RIC treatment for 14 d is safe and well-tolerated in patients with spontaneous intracerebral hemorrhage and can effectively improve the neurological function of patients.

OBJECTIVE To explore the changes of serum mitochondrial ubiquitin ligase(MITOL),β-endorphin(β-EP)and chemokine 10(CXCL10)in the patients with herpes zoster(HZ)virus infection and analyze the predic-tive values.METHODS A total of 137 patients with HZ virus infection who were treated in Jinhua Fifth Hospital from Jan.2022 to Jan.2024 were assigned as the infection group,meanwhile,100 healthy people who received physical examination were chosen as the healthy group.The clinical data were compared between the two groups,the levels of serum MITOL,β-EP and CXCL10 were detected for the two groups of participants.The changes of the above indexes were observed and compared.The values of serum MITOL,β-EP and CXCL10 in prediction of HZ virus infection were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS There were significant differences in the levels of serum MITOL,β-EP and CXCL10 between the infection group and the healthy group(P＜0.05).As the serum MITOL,β-EP and CXCL10 were used for prediction of HZ virus infec-tion,the area under the curve(AUC)of the CXCL10 was the highest 0.932,with the sensitivity 91.24％,the specificity 81.00％;the AUC of the joint detection of the three indexes was 0.882,with the specificity 99.00％,the sensitivity 77.37％(P＜0.05).CONCLUSIONS The patients with HZ virus infection show the decline of MI-TOL and β-EP levels and the rise of CXCL10 level.The three indexes have high values in prediction of HZ virus infection,with the CXCL10 showing the best prediction efficiency.The indexes can be used for prediction of illness condition of the patients with HZ virus infection.

This article summarizes the experience of providing remote nursing care for a pediatric patient with severe burns using augmented reality(AR)technology.Key nursing points include:to establish a remote management team to enhance multidisciplinary collaboration;to conduct remote nursing ward rounds to provide real-time guidance for clinical nursing practice;to remotely guide PICC(Peripherally Inserted Central Catheter)insertions and conduct precise fluid management;to remotely assess ward environments and provide guidance on disinfection and isolation measures;to alleviate pediatric pain through comprehensive management measures.After meticulous care and treatment,the patient's condition stabilized after 23 days,and the patient was transferred to a specialized hospital for continued treatment requiring skin grafting.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To investigate the predictive role of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery.Methods:A prospective cohort study was conducted. The study subjects were singleton pregnant women hospitalized for delivery at the Third Affiliated Hospital of Sun Yat-sen University from February 2021 to December 2022, who had indications for vacuum-assisted delivery, and completed intrapartum ultrasound examination within 10 minutes before the procedure. Intrapartum ultrasound indicators included fetal position, angle of progression (AOP), and head-perineum distance (HPD). Based on the difficulty of vacuum-assisted delivery, the subjects were divided into easy and difficult groups. The fetal position, AOP, and HPD before vacuum-assisted delivery and delivery outcomes were compared between the two groups to explore the correlation and predictive value of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery. Statistical and predictive value analyses were performed using independent-sample t-test, U-test, Chi-square (or Fisher's exact) test, logistic regression analysis, and receiver operating characteristic (ROC) curve. Results:A total of 162 cases were included in the study, with 120 in the easy and 42 in the difficult groups. The age of the 162 pregnant women ranged from 20 to 44 years, with an average of (30.6±3.9) years; 107 cases (66.0%) were first pregnancies, and 139 cases (85.8%) were primipara. (1) The fetal head stations in the difficult and easy groups were 2.3 (2.0-2.5) cm and 2.0 (2.0-2.5) cm, respectively, with no statistically significant difference ( P>0.05). The AOP during the interval and contraction periods and the ΔAOP in the difficult group were smaller than those in the easy group [ (138.1±8.8) vs. (143.8±7.9), t=3.89; (148.7±9.3) vs. (157.9±8.9), t=5.67; and (10.6±6.4) vs. (14.1±6.3), t=3.08; all P<0.01], while the HPD during the interval and contraction periods and ΔHPD in the difficult group were greater than those in the easy group [(3.4±0.5) cm vs. (3.2±0.4) cm, t=－2.69; (2.8±0.5) cm vs. (2.4±0.5) cm, t=－4.70; (－0.5±0.4) cm vs. (－0.8±0.5) cm, t=－2.83; all P<0.01]. (2) In the difficult group, seven cases required forceps delivery after 2-3 vacuum cup detachments; in the easy group, all cases were successfully delivered after 1-2 vacuum tractions. The duration of vacuum extraction was longer in the difficult group [7.0 (6.0-10.0) min vs. 3.0 (2.0-3.0) min, Z=9.65] (all P<0.001). (3) In the difficult group, four cases had severe maternal and neonatal delivery complications, including two cases of shoulder dystocia, one case of vesicovaginal fistula after failed vacuum extraction converted to forceps delivery, and one case of third-degree perineal tear after failed vacuum extraction converted to forceps delivery. In the easy group, one case had shoulder dystocia with mild neonatal asphyxia. The rate of vaginal tears in the difficult group was higher than in the easy group [47.6% (20/42) vs. 29.2% (35/120)] ( χ2=4.72, P=0.030). The incidence of postpartum hemorrhage in the difficult and easy groups was 11.9% (5/42) and 8.3% (10/120), respectively, with no statistically significant difference (Fisher's exact test, P=0.539). No cases required cesarean section after failed vacuum extraction. The incidence of scalp hematoma was higher in the difficult group than in the easy group [28.6% (12/42) vs. 11.7% (14/120), χ2=6.60, P=0.010]. The two groups had no statistically significant differences in the incidence of other neonatal complications. (4) Multivariate logistic regression analysis identified three independent variables associated with difficult vacuum extraction: maternal age, AOP and HPD during contraction. The ROC curve was used to test the predictive value of the multivariate model for difficult vacuum extraction, with an area under the curve of 0.808 (95% CI: 0.734-0.882) ( P<0.001). When the maximum Youden index (0.487) was taken, the sensitivity and specificity of the model in predicting difficult vacuum extraction were 0.762 (95% CI: 0.696-0.828) and 0.725 (95% CI: 0.656-0.794), respectively. Conclusions:AOP and HPD are related to the difficulty of vacuum extraction. The risk of difficult vacuum extraction increases with advanced maternal age, smaller AOP and larger HPD during the contraction phase.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To evaluate the efficacy and safety of the Masquelet technique on the basis of characterization of hematogenous and traumatic chronic osteomyelitis of the tibia.Methods:A retrospective analysis was conducted with chronic tibial osteomyelitis who had been treated by the Masquelet technique at Department of Orthopedic Surgery, The Fourth Medical Center, PLA General Hospital from February 2021 to June 2023. The patients were classified into 2 groups based on the underlying etiology of their conditions: a hematogenous group and a traumatic group. Treatment efficacy was evaluated in terms of infection control rate, bone graft healing time, visual analog scale (VAS) pain score, anxiety measured by the self-rating anxiety scale (SAS), and lower limb function assessed by the lower extremity functional scale (LEFS).Results:A total of 66 patients with chronic tibial osteomyelitis were included in the study. There were 17 cases in the hematogenous group. They were 11 males and 6 females with a median age of 31.0 (15.0, 45.0) years and a median disease duration of 3.0 (1.5, 8.0) months. The median interval between the first and second-stage surgeries was 11.5 (8.0, 13.0) weeks, the median volume of bone defect 25.0 (15.0, 40.0) cm 3, and the median bone graft healing time 4.0 (3.0, 4.0) months. No bacteria were detected in secretion culture in 6 cases and Staphylococcus aureus was found in 6 cases. At 12 months postoperatively, the median VAS score was 1.0 (0.0, 2.0) point, the median SAS score 27.0 (20.0, 32.0) points, and the median LEFS score 78.0 (75.0, 80.0) points. There were 49 cases in the traumatic group. They were 36 males and 13 females with a median age of 52.0 (42.0, 63.0) years and a median disease duration of 6.0 (3.0, 36.0) months. The median interval between the first and second-stage surgeries was 10.0 (8.0, 17.0) weeks, the median volume of bone defect 30.0 (22.0, 53.0) cm 3, and the median bone graft healing time 3.5 (3.0, 4.5) months. No bacteria were detected in secretion culture in 10 cases and Staphylococcus aureus was found in 19 cases. At 12 months postoperatively, the median VAS score was 2.0 (1.0, 3.0) points, the median SAS score 35.0 (28.0, 42.0) points, and the median LEFS score 54.0 (42.0, 60.0) points. According to the McKee criteria for infection treatment, 14 cases achieved complete recovery, 2 ones showed improvement, and 1 case experienced recurrence in the hematogenous group, while 44 cases achieved complete recovery, 4 ones showed improvement, and 1 case experienced recurrence in the traumatic group. Conclusions:Although hematogenous and traumatic cases of chronic osteomyelitis of the tibia differ in terms of age of onset, disease duration, and lesion extent, Staphylococcus aureus is the predominant pathogen in both conditions. Application of the Masquelet technique has proven to be an effective treatment for both conditions with comparable bone graft healing time.

OBJECTIVE To explore the changes of serum mitochondrial ubiquitin ligase(MITOL),β-endorphin(β-EP)and chemokine 10(CXCL10)in the patients with herpes zoster(HZ)virus infection and analyze the predic-tive values.METHODS A total of 137 patients with HZ virus infection who were treated in Jinhua Fifth Hospital from Jan.2022 to Jan.2024 were assigned as the infection group,meanwhile,100 healthy people who received physical examination were chosen as the healthy group.The clinical data were compared between the two groups,the levels of serum MITOL,β-EP and CXCL10 were detected for the two groups of participants.The changes of the above indexes were observed and compared.The values of serum MITOL,β-EP and CXCL10 in prediction of HZ virus infection were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS There were significant differences in the levels of serum MITOL,β-EP and CXCL10 between the infection group and the healthy group(P＜0.05).As the serum MITOL,β-EP and CXCL10 were used for prediction of HZ virus infec-tion,the area under the curve(AUC)of the CXCL10 was the highest 0.932,with the sensitivity 91.24％,the specificity 81.00％;the AUC of the joint detection of the three indexes was 0.882,with the specificity 99.00％,the sensitivity 77.37％(P＜0.05).CONCLUSIONS The patients with HZ virus infection show the decline of MI-TOL and β-EP levels and the rise of CXCL10 level.The three indexes have high values in prediction of HZ virus infection,with the CXCL10 showing the best prediction efficiency.The indexes can be used for prediction of illness condition of the patients with HZ virus infection.

This article summarizes the experience of providing remote nursing care for a pediatric patient with severe burns using augmented reality(AR)technology.Key nursing points include:to establish a remote management team to enhance multidisciplinary collaboration;to conduct remote nursing ward rounds to provide real-time guidance for clinical nursing practice;to remotely guide PICC(Peripherally Inserted Central Catheter)insertions and conduct precise fluid management;to remotely assess ward environments and provide guidance on disinfection and isolation measures;to alleviate pediatric pain through comprehensive management measures.After meticulous care and treatment,the patient's condition stabilized after 23 days,and the patient was transferred to a specialized hospital for continued treatment requiring skin grafting.

Objective To evaluate clinical effect of remote ischemic conditioning(RIC)in patients with spontaneous intracerebral hemorrhage(sICH).Methods Sixty-four patients with sICH who were diagnosed and admitted to the Department of Neurosurgery,the Sixth Medical Center of PLA General Hospital from January 2023 to May 2024 were selected as research subjects.Following the principle of matching baseline characteristics between groups,a computerized random grouping program was used to divide them into an observation group of 32 cases and a control group of 32 cases.Patients in the control group received standard basic medication according to the'Chinese Clinical Management Guidelines for Cerebrovascular Diseases',while the observation group received RIC treatment in addition to the control group's treatment,with a course of 14 d.The changes in National Institutes of Health Stroke Scale(NIHSS)scores and Barthel index(BI,daily living ability score table)on the day of admission and after 14 d of treatment,the changes in hematoma volume on computed tomography(CT)imaging,and the incidence of adverse events were compared between the two groups.Results At admission,the difference is not statistically significant in NIHSS scores,BI,and CT imaging hematoma volume between the two groups(P>0.05).After 14 d of treatment,the NIHSS scores of both groups were reduced compared to before treatment,and the scores of the observation group were lower than those of the control group(P<0.05);the BI of both groups was increased compared to before,and the scores of the observation group were higher than those of the control group(P<0.05);there were no significant differences in CT imaging hematoma volume and the incidence of adverse events between the two groups(P>0.05).Conclusion Continuous RIC treatment for 14 d is safe and well-tolerated in patients with spontaneous intracerebral hemorrhage and can effectively improve the neurological function of patients.