ObjectiveThis paper aims to investigate and evaluate the staged efficacy and safety of the representative empirical prescription of the “Zhu Ke Jiao” theory， Qijia Rougan prescription， combined with entecavir in the treatment of hepatic fibrosis in chronic hepatitis B. MethodsA multicenter randomized controlled clinical study was conducted， and 101 patients diagnosed with chronic hepatitis B-related hepatic fibrosis （CHB-HF） who met the diagnosis and inclusion criteria were randomly assigned to an observation group （Qijia Rougan prescription + entecavir） and a control group （entecavir）. The treatment duration was 24 weeks. Liver stiffness measurement （LSM）， fibrosis-4 index （FIB-4）， portal vein diameter， hepatitis B serology， biochemical indicators， hepatic fibrosis markers in serum ［hyaluronic acid （HA）， laminin （LN）， procollagen Ⅲ peptide （PⅢP）， and type Ⅳ collagen （Ⅳ-C）］， and traditional Chinese medicine syndrome scores were used as efficacy evaluation indicators. Efficacy assessments and explorations of different staged subgroups of Qijia Rougan prescription were conducted according to LSM values based on the Metavir pathological staging standard. ResultsA total of 98 cases were included for statistical analysis， with 49 cases in the observation group and 49 in the control group. The general data of the patients in both groups were comparable. Compared with the same group before treatment， the observation group showed a significant reduction in LSM and FIB-4 （P<0.01）， as well as notable improvements in LN， Ⅳ-C， and various TCM syndrome scores （P<0.05， P<0.01）. When compared to the control group after treatment， the observation group demonstrated significant improvements in LSM， FIB-4， and various TCM syndrome score indicators （P<0.05， P<0.01）， indicating that the observation group performed better than the control group. Subgroup analysis of the regression of hepatic fibrosis stages showed that compared to the same group before treatment， the observation group had better improvement in regression of stages F2 and F3 （P<0.05）. When compared to the control group after treatment， the observation group exhibited superior improvement in regression of stage F3 （P<0.05）. No adverse events occurred in either group during the treatment period. ConclusionCompared with entecavir alone， the combination of Qijia Rougan prescription and entecavir significantly improves the degree of hepatic fibrosis and clinical TCM symptoms in patients. The optimal intervention period is primarily during stage F3， which is a potential “interception” point of the “Zhu Ke Jiao” theory.

Objective To investigate the expression and prognostic value of microRNA-29b-2-5p(miR-29b-2-5p)and syntaxin 16(STX16)in hepatocellular carcinoma(HCC).Methods The cancer tissues and adjacent tissues of 88 HCC patients diagnosed in Nantong Tumor Hospital from January 2013 to September 2020 were collected.The expressions of miR-29b-2-5p and STX16 in cancer tissues and adjacent tissues were analyzed by real-time fluorescent quantitative PCR.The expression of STX16 protein in cancer tissues and adjacent tissues were analyzed by immunohistochemistry.Pearson correlation analysis was used to analyze the correlation be-tween miR-29b-2-5p and STX16.Non-parametric χ2 test was used to analyze the relationship between the ex-pression of the two proteins and clinicopathological parameters,and Kaplan-Meier survival curve was used to analyze the relationship between the expression of the two proteins and prognosis.Results The relative ex-pression level of miR-29b-2-5p was 0.780(0.351,1.708)in cancer tissues and 1.014(0.458,3.124)in adja-cent tissues in 88 HCC patients.The relative expression level of miR-29b-2-5p in cancer tissues was signifi-cantly lower than that in adjacent tissues(P=0.012).The relative expression level of STX16 mRNA was 0.775(0.406,0.946)in cancer tissues and 0.368(0.080,1.301)in adjacent tissues in 88 HCC patients.The relative expression level of STX16 mRNA in cancer tissues was significantly higer than that in adjacent tissues(P<0.01).Immunohistochemical results showed that STX16 was expressed in the cytoplasm,and the expres-sion of STX16 in cancer tissues was higher than that in adjacent tissues(P<0.05).The expression of miR-29b-2-5p in cancer tissues was related to cancer stage(P<0.05),and the expression of STX16 was related to cancer stage and alpha-fetoprotein(P<0.05).Patients with low miR-29b-2-5p expression had a shorter over-all survival(OS)than those with high miR-29b-2-5p expression,and patients with high STX16 expression had a shorter OS than those with low STX16 expression(P<0.05).Conclusion The expression of miR-29b-2-5p is low and STX16 is high in HCC tissues.The combined detection of miR-29b-2-5p and STX16 can effectively evaluate the prognosis of HCC patients.

Objective To investigate the value of unenhanced CT combined with clinical features in predicting adnexal torsion in women with abdominal pain and an adnexal mass. Methods A retrospective selection of patients with abdominal pain and an adnexal mass underwent operation in 2 tertiary hospitals from January 2018 to September 2023. The torsion group (n＝53) and non-torsion group (n＝53) were matched in a 1∶1 ratio. 15 CT signs of adnexal masses were reviewed independently by two radiologists using a double-blind method. The high-risk factors were screened using multivariate logistic regression analysis. The diagnostic values of high-risk factors for adnexal torsion were assessed using receiver operating characteristic (ROC) curves. Results According to the surgical and pathological results, the most common adnexal mass in torsion group was mature cystic teratoma (32.1%), and the most common mass in the non-torsion group was adnexal abscess (20.8%). The age, fever rate, white blood cell count, location of mass, thickened fallopian tube rate, and pelvic effusion rate were not statistically different between the two groups, the nausea and vomiting and remaining CT signs were significant different between the two groups (P＜0.05). Multivariate logistic analysis showed that nausea and vomiting (OR＝4.886), navel sign (OR＝22.733), and whirl sign (OR＝43.462) were independently associated with adnexal torsion (P＜0.05). The area under the curve (AUC) of nausea and vomiting, navel sign, and whirl sign were 0.717, 0.802, and 0.840, respectively; AUC of the combination of all three was 0.877 with 92.45% of sensitivity, 84.91% of specificity, 85.96% of positive predictive value, 91.84% of negative predictive value, and 88.68% of accuracy. Conclusions For women with abdominal pain and an adnexal mass, nausea and vomiting, navel sign, and whirl sign are help of predicting adnexal torsion, and combination value of all three is best.

BACKGROUND:With the progress of minimally invasive procedures of the spine,endoscopic lumbar decompression has been widely used in the treatment of lumbar disc herniation.The indications of different endoscopic surgical approaches are different,and the decision of the specific operation plan needs to be combined with the actual situation and the choice of clinical surgeons. OBJECTIVE:To investigate the short-term effect in treatment of single-level lumbar disc herniation by percutaneous endoscopic visual trephine arthroplasty. METHODS:Ninety patients with single-level lumbar disc herniation admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 who met the inclusion criteria were included in this study.According to different approaches of percutaneous endoscopic visual trephine arthroplasty,they were divided into transforaminal approach group(control group,n=48 cases)and translaminar approach group(trial group,n=42 cases).The general information of patients in the two groups was recorded,including sex,age,disease course,body mass index,incision length,operation time,intraoperative fluoroscopy times,length of hospital stay,and amount of blood loss.Visual analog scale score of pain and Japanese Orthopaedic Association score at different follow-up stages were assessed.The modified MacNab standard was used to evaluate the clinical outcome at the last follow-up,and the postoperative complications and recurrence rate were measured. RESULTS AND CONCLUSION:(1)The operation time and intraoperative fluoroscopy times of the trial group were less than those of the control group,and the difference was statistically significant(P<0.05).However,there were no significant differences in intraoperative blood loss,incision length,and hospital stay between the two groups(P>0.05).(2)There was no significant difference in visual analog scale score of pain and Japanese Orthopaedic Association score between the two groups before surgery(P>0.05).However,visual analog scale of pain and Japanese Orthopaedic Association score were significantly improved 1 week,3,6,and 12 months after surgery(P<0.05).(3)At the last follow-up,the good and good rate of modified MacNab standard was 94%in the control group and 95%in the trial group.(4)In the control group,one patient still felt back and leg pain after surgery,underwent open surgery,and recovered well after surgery without obvious sequelae.There were no postoperative complications or recurrent cases in the trial group.(5)It is concluded that both percutaneous transforaminal approach and interlaminar approach have good short-term clinical efficacy and high patient satisfaction in the treatment of single-level lumbar disc herniation,but the time of the interlaminar approach is shorter and has less intraoperative fluoroscopy times.

Objective:To investigate the effect of dexmedetomidine (DEX) on reducing urethral stimulation in patients undergoing laparoscopic gastrointestinal surgery.Methods:From January 2019 to February 2020, 90 patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia in the Third Affiliated Hospital of Sun Yat-sen University were selected. They were randomly divided into 3 groups: catheterization before induction (group A), catheterization during induction (group B), and catheterization after induction (group C). In group A, patients received general anesthesia after awake catheterization. In group B, intravenous injection of DEX 0.5 μg/kg was pumped for 10 minutes, followed by catheterization and induction. In group C, patients received general anesthesia and then catheterization. Visual analogue scale (VAS) score of urethral stimulation, morphine dosage and the incidence of agitation during resuscitation were recorded. The heart rate and mean arterial pressure of the three groups were compared at the time of entering the room, catheterization, tracheal intubation, entering postanesthesia care unit (PACU), about extubation and 30 minutes after extubation.Results:The fluctuation of blood pressure and heart rate in group B was significantly less than that in group A and group C at the time of extubation and 30 minutes after extubation ( P<0.05). VAS of urethral stimulation in group B [(2.9±0.9)point] was significantly lower than that in group A [(4.4±1.8)point] when catheter was indwelling ( P<0.05). After extubation, VAS in group B [(2.8±1.1)point] was significantly lower than that in group A [(3.2±1.2)point] and C [(5.2±1.8)point] ( P<0.05). The utilization rate of morphine within 24 hours after surgery in group B (10%) was significantly lower than that in the other two groups (40%, 57%), and the incidence of postoperative agitation in group A and B was lower than that in group C within PACU ( P<0.05). The satisfaction of patients in group B (86.7%) was higher than that in group A (70%) and C (46.7%). The satisfaction of PACU personnel in group A (76.7%) and B (80%) was significantly higher than that in group C (43.3%). Conclusions:Sedation with dexmedetomidine during urethral catheterization can reduce urethral stimulation during resuscitation and improve patients' and PACU staffs' satisfaction.

Objective To investigate the prevalence of healthcare-associated infection(HAI)in a tumor hospital,and provide evidence for prevention and control of HAI.Methods According to requirement of cross sectional survey of nationwide HAI monitoring network,prevalence rates of HAI in hospitalized patients at a tumor hospital in 2013-2015 were surveyed,surveyed results were statistically analyzed.Results A total of 3 515 hospitalized patients were investigated from 2013 to 2015,24(0.68%)had HAI.The prevalence rates of HAI from 2013 to 2015 were 0.79%,0.54%,and 0.76%respectively,difference was not statistically significant(x2=0.65,P>0.05).The main infection site was lower respiratory tract,accounting for 45.83%.The main pathogens causing HAI were gram-negative bacilli,accounting for 47.37%,followed by fungi(26.32%).Conclusion The prevalence rate of HAI in tumor patients is low,targeted monitoring should be carried out according to the current situation,the prevention and control of lower respiratory tract infection should be focused on,fungal infection should be paid attention.

Objective To evaluate the technique and clinical results of the modular fluted tapered stems for treating periprosthetic femoral fractures in revision hip arthroplasty.Methods From August 2007 to February 2014,fourteen patients (14hips) with periprosthetic femoral fractures underwent revision hip arthroplasty with modular fluted tapered stem.A retrospective analysis was performed involving all patients who were followed-up more than 2 years.The subjects consisted of 4 males and 10 females with mean age of 73.4±6.6 years (range,62-82 years) at the time of revision.All patients were unilateral with 8 left hips and 6 right hips.The status of primary arthroplasty was bipolar hemiarthroplasty in 3 patients and total hip arthroplasty in 11 patients.Nine cases were with cemented stems,5 cases with uncemented stems.The interval from primary hip arthroplasty to revision surgery ranged from 40 to 163 months,with an average of 120.9±31.9 months.Eight cases with Vancouver type B3 periprosthetic femoral fracture were found preoperatively,6 cases with aseptic loosening and bone deficiency occurred periprosthetic femoral fracture during the operation.Based on the Paprosky classification system for femoral bone deficiency:type ⅢA in 8 hips,type ⅢB in 5 hips,type Ⅳ in 1 hip.Both the femoral and the acetabular components were revised in 9 patients.All femoral fractures were treated with cable fixation,and the cortical allograft struts were used to augment femoral bone stock in 7 patients.The patients were followed up at 6 weeks,3 months,6 months,9 months,12 months and annually thereafter.Harris Hip Score System and radiographic examination was used to evaluate the clinical results,including fracture union,implant stability,bone stock,hip joint function and postoperative complications.Results The mean duration of follow-up was 62.1 ±22.2 months (range,30-96 months).The mean times of fracture union were 6.2±2.5 months (range,3-12 months).The Harris Hip Score improved from 29.6± 10.3 preoperatively to 86.3±4.2 postoperatively (t=-21.6,P=0.00).Thirteen cases (93％,13/14) had the stem subsidence of 4.9±2.5 mm (range,0-9 mm).Thirteen cases (93％,13/14) were presented with femoral bony restoration.Two cases showed incorporation of the allograft in 7 patients.One patient developed deep venous thrombosis of lower limbs,and one suffered from subcutaneous hematomas after surgery.There was no infection,aseptic loosening,dislocation or periprosthetic fracture complications at the followup.Conclusion The short-medium term results of the modular fluted tapered prosthesis applied in periprosthetic femoral fractures are encouraging in revision hip arthroplasty.The present technology can provide reliable primary stability and can tolerate minimal subsidence postoperatively.

BACKGROUND:Three-dimensional (3D) printing technology has been successful y used in the field of joint replacement, fracture fixation and spinal implant, but the potential of 3D printing technology in the field of surgery for ossification of posterior longitudinal ligament of cervical spine remains to be discussed. OBJECTIVE:To determine the application value of a 3D printing model in the selection of anterior and posterior surgical decompression for cervical ossification of the posterior longitudinal ligament. METHODS:A retrospective analysis was carried out involving 15 patients with ossification of the posterior longitudinal ligament col ected by computed tomography (CT) and printed by a 3D model pre-operatively between October 2014 and October 2015 in Affiliated Hospital of Xuzhou Medical University. There were isolated type (n=2), segmental type (n=6), continuous type (n=4), and combined type (n=3). The application value of a 3D printer model in patients with ossification of the posterior longitudinal ligament was evaluated by Japanese Orthopedic Association scores, Visual Analog Scale scores, symptoms, and imaging data 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up. RESULTS AND CONCLUSION:(1) Al 15 patients underwent successful treatment of cervical spine decompression surgery and were fol owed up for 4-16 months. The post-operative symptoms were relieved more significantly than the pre-operative symptoms. Using the posterior approach for cervical spinal surgery, 1 patient had incision fat necrosis and healed after negative pressure drainage. (2) Japanese Orthopedic Association scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 9.0±1.6, 11.7±1.8, and 15.5±1.4, respectively;the differences were statistical y significant (P<0.05). Visual Analog Scale scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 6.7±2.5, 2.13±1.4, and 1.4±0.5, respectively;the difference was statistical y significant (P<0.05). (3) The imaging results at fol ow-up showed that the anterior interbodies were fused, and the pivot of the posterior operation was healed wel without a re-closing phenomenon. (4) A 3D printer model was shown to be beneficial in observing the characteristics of cervical ossification of the posterior longitudinal ligament, performing the pre-operative evaluation, and simulating the surgical procedure. There was value for the choice of operative approach.

Objective To evaluate the efficacy and safety of total knee arthroplasty (TKA) with 3D printing guild plate by comparing with conventional TKA. Methods From May 2014 to September 2014, 40 patients suffered primary unilateral TKA were received, in which there were 11 males and 29 females, aged from 57 to 82 years with an average age of 68.5±6.3 years. The subjects were divided into two groups randomly. One group was treated with TKA with 3D printing guild plate while the other group was treated with the conventional TKA. The blood loss, operation time, post?operative Hospital for Special Surgery (HSS) score, range of motion (ROM), lower limb mechanical alignment and incidence of complication were compared with insignificant differences. Results The operation time in the 3D printing TKA group (103.4±11.7 min) was lower than that in the conventional TKA group (124.5±21.6 min), which was statistically significant (t=3.838, P=0.000). The blood loss in the 3D printing TKA group (370.2±96.0 ml) was lower than that in the conventional TKA group (510.0±235.9 ml), which was statistically significant (t=2.454, P=0.019). The post?operative ROM of knee in the 3D printing TKA group was 104.3° ± 15.5° and that in the conventional TKA group was 103.5° ± 12.5° (t=0.169, P=0.867). HSS scores in the 3D printing TKA group and in the conventional TKA group were 88.5±5.7 and 89.4±4.8, which was statistically insignificant (t=-0.633,P=0.530). Mechanical alignment in the 3D printing TKA group was 2.9°±1.1° and that in the conventional TKA group was 3.0°±0.9°, which was not statistically significant (t=-0.317, P=0.753). No obvious complication occurred in two groups. Conclusion TKA with 3D printing guild plate has similar results to conventional TKA in HSS score, mechanical alignment and ROM of knee, but it shortens operation time and decreases the blood loss.

BACKGROUND:Spinal posterior surgery is the most common treatment method for thoracolumbar fracture. During exposure of conventional posterior surgery, a wide-range stripping and pul ing of paraspinal muscles easily induced failure syndrome of lumbar surgery.
OBJECTIVE:To compare the reset conditions and stability of thoracolumbar fractures after treatment with pedicle screw paraspinal muscle approach and conventional posterior median approach fixation.
METHODA total of 62 patients with thoracolumbar fractures without nerve injury were retrospectively analyzed. 22 patients were treated with paraspinal muscle approach and general spine system. 21 patients were treated with conventional median approach and general spine system. 19 patients were treated with conventional median approach and AF internal fixation system. The therapeutic effects of the three kinds of fixation methods were compared by comparing clinical indexes in patients of the three groups, including operation time, intraoperative blood loss, postoperative drainage, dead space volume, scores of the Visual Analogue Scale of back pain, wound complications, height of injured vertebrae and the Cobb angle.
RESULTS AND CONCLUSION:Operation time, intraoperative blood loss, postoperative drainage and dead space volume were better in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group (P<0.05). No significant difference in height of injured vertebrae and the Cobb angle was detectable among the three groups at 3 days after fixation (P>0.05). No significant difference in scores of the Visual Analogue Scale of back pain was visible among the three groups at 1 week after fixation (P>0.05). The scores of the Visual Analogue Scale of back pain were apparently lower in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group at 3 and 6 months after fixation. No incision infection was observed in patients of the three groups. These results suggested that compared with conventional posterior median approach, paraspinal muscle approach has some advantages, such as smal trauma, less bleeding, postoperative rapid recovery, and high degree of satisfaction. The effects of general spine system and AF internal fixation system in the repair of thoracolumbar fractures on internal fixation are similar, but general spine system has some advantages such as simple to be operated, save time, less bleeding, stable fixation and good reduction. General spine system combined with paraspinal muscle approach is a good method to repair thoracolumbar spine fracture.