Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

To develop a novel polyamino acid-based nanohydrogel drug delivery system for dexamethasone to enhance its delivery efficiency to the inner ear.

Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective To evaluate the role of autophagy in the treatment of neuropathic pain(NP)with hydrogen-rich saline.Methods Forty adult male Sprague-Dawley rats with successful intubation were randomly divided into 5 groups(n= 8)using a random number table:the sham operation group(group S),the neuropathic pain group(group C),the hydrogen-rich saline group(group H),the autophagy inhibitor group(group M)and the hydrogen-rich saline + autophagy inhibitor group(group HM).There were 8 rats in each group.The NP model was established by chronic constriction of the sciatic nerve(CCI)in rats.The autophagy inhibitor 3-methyladenine(3-MA)was intraperitoneally injected with 30μg/kg in the group M and the group HM.The hydrogen-rich saline(0.6 mmol/L)was intraperitoneally injected with 10 mL/kg in the group H and the group HM.The other groups were intraperitoneally injected with the same amount of normal saline twice a day for 7 consecutive days.Paw withdrawal threshold to mechanical stimulation(MWT)and paw withdrawal latency to thermal stimulation(TWL)were measured at 1 day before and 1,3,5,7 and 14 days after modeling(T0-T5).After the last measurement of pain threshold,the L4-L6 segment of spinal cord was removed for determination of the expression of autophagy-related proteins microtubule-associated protein light chain 3(LC3)Ⅱ,Beclin-1 and p62 proteins by Western blot assay.The expression levels of superoxide dismutase(SOD)and malondialdehyde(MDA)in spinal cord tissue were detected.Results Compared with the group S,MWT and TWL were decreased in the group C at T2-5,the expression levels of LC3 Ⅱ,Beclin-1 and p62 were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group C,MWT and TWL were increased in the group H at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).MWT and TWL were decreased in the group M at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were decreased,p62 protein expression levels were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group M,MWT and TWL were increased in the group HM at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).Conclusion Hydrogen-rich saline can alleviate neuropathic pain and inhibit oxidative stress in spinal cord in rats,and the mechanism may be related to the increase of autophagy.

Objective To compare the effectiveness and safety of ketamine and etomidate for rapid sequential intubation. Methods Randomized controlled trials and cohort studies with ketamine and etomidate for RSI in patients with acute and critical illnesses published by China National Knowledge Infrastructure, Wanfang Data, VIP Network, PubMed, Embase, Cochrane Library and Clinicaltrials.gov from the date of database creation to May 1, 2023 were searched by computer. The literatures were screened according to inclusion and exclusion criteria, and the data of literatures were also extracted for quality assessment. Meta-analysis was performed by RevMan 5.3 software. Results A total of 15 literatures with 20 839 patients were included, including 3 RCT studies and 12 cohort studies. Meta-analysis showed that there were no significant differences in the success rate of primary intubation (RR=0.99, 95 %CI, 0.98 to 1.00, P=0.10), incidence of cardiac arrest (RR=1.00, 95 %CI, 0.62 to 1.62, P=0.99), time of mechanical ventilation (MD=0.33, 95 %CI, -0.34 to 1.01, P=0.33), and mortality rate (RR=1.05, 95 %CI, 0.95 to 1.16, P=0.31) between the ketamine group and the etomidate group, but the incidence of adrenal insufficiency (RR=0.54, 95 %CI, 0.41 to 0.70, P < 0.001) and ICU stay (MD=-0.44, 95 %CI, -0.70 to -0.18, P=0.001) in the etomidate group were significantly lower and shorter than those in the ketamine group, while the incidence of hypoxemia was significantly higher in the etomidate group (RR=1.50, 95 %CI, 1.27 to 1.79, P < 0.001). Conclusion During the process of RSI with sufficient preoxygenation, ketamine is a safe and effective alternative drug, and compared with etomidate, it has a lower incidence of adrenal insufficiency and shorter ICU stay.

Objective:To provide references for effective intervention of hyperuricemia (HUA) by investigating the prevalence of HUA in military pilots and analyzing its relevant influencing factors.Methods:The physical examination data of 2 700 military pilots who received physical examinations from January 2021 to October 2023 were retrospectively analyzed. The above pilots were divided into HUA group and non-HUA group according to whether they had HUA. The differences in age, height, weight, body mass index, flying hours, blood pressure, blood uric acid, fasting blood glucose, total bilirubin, albumin, blood urea nitrogen, blood creatinine, alanine aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels, as well as the prevalence of hypertension, hyperlipidemia, and fatty liver were compared between 2 groups. The pilots were grouped by age (≤29 years, 30-39 years, 40-49 years,≥50 years) and by the aircraft types (fighter, bombers, transporter, helicopter). The criteria for determining HUA, hypertension, hyperlipidemia, and fatty liver were based on the relevant guidelines. The influencing factors for the prevalence of HUA were analyzed through binary Logistic regression. Single factor binary Logistic regression was used to analyze the influencing factors of the prevalence of HUA in pilots, and P<0.05 index was included in multi-factor binary Logistic regression to further analyze the influencing factors of the occurrence of HUA. Results:There were 821 cases (30.41%) in HUA group and 1 879 cases (69.59%) in non-HUA group. The weight ( t=7.75, P<0.001), body mass index ( t=8.23, P<0.001), systolic blood pressure ( t=3.20, P=0.001), diastolic blood pressure ( t=3.06, P=0.002), serum uric acid ( t=62.83, P<0.001), blood urea nitrogen ( t=3.41, P=0.001), serum creatinine ( t=8.88, P<0.001), alanine aminotransferase ( t=5.56, P<0.001), total cholesterol ( t=3.27, P=0.001), triglyceride ( Z=9.54, P<0.001), as well as the prevalence of hypertension ( χ2=7.48, P=0.006), hyperlipidemia ( χ2=42.74, P<0.001), and fatty liver ( χ2=22.51, P<0.001) in HUA group were higher than those in non-HUA group, while high-density lipoprotein cholesterol was lower than that in the non-HUA group, and the difference was significant ( t=5.91, P<0.001). There was no significant difference in the prevalence of HUA among pilots of different age groups and aircraft types (both P>0.05). Overweight ( OR=1.392, 95% CI: 1.159-1.672), obesity ( OR=1.891, 95% CI: 1.197-2.987), and elevated level of triglyceride ( OR=1.246, 95% CI:1.128-1.377), blood urea nitrogen ( OR=1.079, 95% CI:1.000-1.163), and serum creatinine ( OR=1.036, 95% CI:1.028-1.044) were risk factors for HUA, and elevated high density lipoprotein cholesterol ( OR=0.567, 95% CI: 0.389-0.825) was a protective factor. Conclusions:The prevalence of HUA in military pilots is higher than that in the general population. Overweight, obesity, and elevated level of triglyceride, blood urea nitrogen, and serum creatinine are closely related to the prevalence of HUA, and comprehensive intervention measures should be taken for key targets.

Objective:To provide references for effective intervention of hyperuricemia (HUA) by investigating the prevalence of HUA in military pilots and analyzing its relevant influencing factors.Methods:The physical examination data of 2 700 military pilots who received physical examinations from January 2021 to October 2023 were retrospectively analyzed. The above pilots were divided into HUA group and non-HUA group according to whether they had HUA. The differences in age, height, weight, body mass index, flying hours, blood pressure, blood uric acid, fasting blood glucose, total bilirubin, albumin, blood urea nitrogen, blood creatinine, alanine aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels, as well as the prevalence of hypertension, hyperlipidemia, and fatty liver were compared between 2 groups. The pilots were grouped by age (≤29 years, 30-39 years, 40-49 years,≥50 years) and by the aircraft types (fighter, bombers, transporter, helicopter). The criteria for determining HUA, hypertension, hyperlipidemia, and fatty liver were based on the relevant guidelines. The influencing factors for the prevalence of HUA were analyzed through binary Logistic regression. Single factor binary Logistic regression was used to analyze the influencing factors of the prevalence of HUA in pilots, and P<0.05 index was included in multi-factor binary Logistic regression to further analyze the influencing factors of the occurrence of HUA. Results:There were 821 cases (30.41%) in HUA group and 1 879 cases (69.59%) in non-HUA group. The weight ( t=7.75, P<0.001), body mass index ( t=8.23, P<0.001), systolic blood pressure ( t=3.20, P=0.001), diastolic blood pressure ( t=3.06, P=0.002), serum uric acid ( t=62.83, P<0.001), blood urea nitrogen ( t=3.41, P=0.001), serum creatinine ( t=8.88, P<0.001), alanine aminotransferase ( t=5.56, P<0.001), total cholesterol ( t=3.27, P=0.001), triglyceride ( Z=9.54, P<0.001), as well as the prevalence of hypertension ( χ2=7.48, P=0.006), hyperlipidemia ( χ2=42.74, P<0.001), and fatty liver ( χ2=22.51, P<0.001) in HUA group were higher than those in non-HUA group, while high-density lipoprotein cholesterol was lower than that in the non-HUA group, and the difference was significant ( t=5.91, P<0.001). There was no significant difference in the prevalence of HUA among pilots of different age groups and aircraft types (both P>0.05). Overweight ( OR=1.392, 95% CI: 1.159-1.672), obesity ( OR=1.891, 95% CI: 1.197-2.987), and elevated level of triglyceride ( OR=1.246, 95% CI:1.128-1.377), blood urea nitrogen ( OR=1.079, 95% CI:1.000-1.163), and serum creatinine ( OR=1.036, 95% CI:1.028-1.044) were risk factors for HUA, and elevated high density lipoprotein cholesterol ( OR=0.567, 95% CI: 0.389-0.825) was a protective factor. Conclusions:The prevalence of HUA in military pilots is higher than that in the general population. Overweight, obesity, and elevated level of triglyceride, blood urea nitrogen, and serum creatinine are closely related to the prevalence of HUA, and comprehensive intervention measures should be taken for key targets.

In recent years， neurotoxicity caused by traditional Chinese medicine （TCM） has frequently occurred and has become one of the important factors restricting the development and application of TCM. TCM contains active components and its dosage-effect relationship is the key to determine its pharmacological activity and toxic effects. Among them， the endogenous toxic components include alkaloids， glycosides， diterpenoids， animal and plant toxic proteins and heavy metals， and so on； exogenous toxic components mainly refer to some harmful elements and pesticide residues during the cultivation， processing， transportation and storage of medicinal materials that are not synthesized by themselves. Effect on the processes such as oxidative stress， inflammation， ion exchange， and energy metabolism may be important mechanisms of TCM-induced neurotoxicity. Neural cells， myelin cells， axons and neurotransmitter systems are common targets of TCM-induced neurotoxicity. In the future， we can use modern research methods and big data mining means to establish a safety evaluation mode of “toxic symptoms-poisoning dose-toxic original agent-detoxification scheme” with the basic component group of toxic substances as the core， so as to provide support for development and clinical intervention of neurotoxic traditional Chinese medicine.

Objective:To explore the role of activated CD4 + T cells in cardiac remodeling after myocardial infarction (MI). Methods:① Experiment in vitro: naive CD4 + T cells were isolated in mouse spleen, and then stimulated with plate-bound anti-CD3 and anti-CD28 for 48 hours. Exosomes isolated from the supernatant of activated CD4 + T cells were incubated with cardiac fibroblasts (CFs) for 48 hours, and then the ability of CFs proliferation, migration and differentiation were detected by cell counting kit-8 (CCK-8) assay, Transwell assay, and immunofluorescence assay. ② Experiment in vivo: 40 male C57 mice were divided into 4 groups according to random number table method, including control group (Ctrl group), sham operation group (Sham group), MI group, and exosome treatment group (MI+Exo group), with 10 in each group. The mice model of MI was established by ligating the left anterior descending coronary artery. In MI+Exo group, 40 μg/d exosomes were injected intravenously into the tail after modeling. Cardiac function and cardiac fibrosis post-MI were assessed by echocardiography and quantitative polymerase chain reaction (qPCR) at 4th week. Results:① In vitro: exosomes derived from activated CD4 + T cells significantly promote CFs proliferation, migration and differentiation [proliferation ability ( A value): 0.31±0.01 vs. 0.21±0.01, migration capability (cells/MP): 79.20±3.34 vs. 48.80±2.13, differentiation ability (α-smooth muscle actin, α-SMA; fluorescence intensity): 1.56±0.03 vs. 1.00±0.02, all P < 0.05]. ② In vivo: echocardiographic analysis showed that exosomes derived from activated CD4 + T cells aggravated the deterioration of cardiac dysfunction post-MI than MI group, as indicated by left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased significantly [LVEF: 0.185±0.008 vs. 0.257±0.022, FS: (9.72±1.72)% vs. (14.08±1.08)%, both P < 0.05], left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) increased significantly [LVEDD (mm): 5.43±0.29 vs. 4.62±0.35, LVESD (mm): 4.94±0.12 vs. 3.69±0.29, both P < 0.05]. Additionally, qPCR showed that exosomes derived from activated CD4 + T cells remarkably promoted myocardial fibrosis post-MI than MI group, as indicated by the mRNA expression of α-SMA, collagens (Col1a1, Col3a1) in MI+Exo group was significantly higher than that in MI group [α-SMA (2 -ΔΔCT): 4.72±0.89 vs. 3.58±0.78, Col1a1 (2 -ΔΔCT): 6.59±0.56 vs. 4.23±0.42, Col3a1 (2 -ΔΔCT): 13.40±1.03 vs.4.96±0.36, all P < 0.05]. Conclusion:Activated CD4 + T cells promote cardiac remodeling following MI through transferring exosomes to CFs.

Objective: To explore the impact of function of mobile phone use on self-perceived stress and mobile phone addiction of high vocational students, and the mediating role of coping styles between different mobile phone functions and mobile phone addiction. Methods: A total of 911 participants in two vocational colleges in Wuhan and Liaocheng were investigated by using convenient sampling method. Smartphone Usage, Simplified Coping Style Questionnaire, and Stress subscale of Depression-Anxiety-Stress Scale(short version) were administered to participants. Results: Female students scored significantly higher on mobile phone social features (4.77±1.06) than males( t =2.05， P =0.04), while males scored significantly higher on MPATS and DASS-S, Negative Coping Style subscales than females( P <0.01). The social function of the mobile phone was positively related to the positive coping styles( r =0.17, P <0.01). The game features of mobile phone were positively related to negative coping styles, stress and mobile addiction( P <0.01). Negative coping style could positively predict stress and mobile phone addiction( β =0.53, 0.50, P <0.01). Negative coping styles and stress had significant chain mediation effects in nonsocial functions and mobile phone addiction(95% CI =0.06-0.24, P <0.01). Conclusion Students of vocational college who often use cellphone not for social purpose have higher self-perceived stress. The game function of mobile phones had an adverse effect on the physical and mental health of vocational students. Negative coping style is a powerful predictor of stress and mobile phone addiction.