Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

One hundred patients underwent coronary artery bypass grafting and thirty patients underwent replacement of mitral valve were included in this study, and patients were randomized to two groups. Adenosine group (group I):6 mg adenosine was diluted with physiological saline and injected from the root of the ascending aorta after blocking it. The aorta was then perfused with high-potassium cold-blood cardioplegia. Control group (group II):the aorta was just perfused with high-potassium cold-blood cardioplegia. Adenosine was only added in first perfusion in adenosine group. Both groups were reperfused half-amount of cold-blood cardioplegia containing potassium every 30 minutes. Relevant clinical indexes and myocardial enzymological determination were compared between two groups. Results For patients who underwent CABG, the cardiac arrest induced time,ICU dwell and assisted ventilation time after surgery and dopamine usage were all less in adenosine group than those of control group (P < 0.05). There were no significant differences in the total number of cardioplegia of perfusion fluid, the total amount of perfusion, clamping aorta and assisting circulation times and automatic rebeating between two groups (P>0.05). For patients who underwent MVR, the cardiac arrest induced time and dopamine usage were all less in adenosine group than those of control group (P<0.05). There were no significant differences in times and total number of cardioplegia of perfusion fluid, clamping aorta and assisting circulation times, ICU dwell and assisted ventilation time after surgery automatic rebeating between two groups (P>0.05). For both operations, 4 hours after clamping aorta, creatine kinase isoenzyme (CK-MB) was less in adenosine group than that of control group (P<0.01 or P<0.05), and 4 hours and 24 hours after bypass, cardiac troponin I (cTnI) was significantly higher in control group than that of adenosine group (P < 0.05). Conclusion After aorta is clamped, immediate injection of adenosine diluent and cold-blood cardioplegia containing potassium from the root of the ascending aorta can lead to quick heart arrest, reduce the release of myocardial enzymes and dosage of vasoactive agents, and shorten ICU dwell and assisted ventilation time.

Objective To investigate the relationship between liver cancer and the water environment, we analyzed the life expectancy in 14 counties (districts), which form the Huai River Basin with respect to liver cancer deaths in 2013 and changes in the surface water quality from 2004 to 2010. Methods The study area included the 14 counties (districts) of the Huai River Basin in China. We obtained surveillance data for all causes of death in the study area during 2013, as well as data for International Classification of Diseases,Tenth Edition(ICD-10) code C22 or liver cancer. Life expectancy and life expectancy after elimination of liver cancer were then calculated. Based on water quality monitoring data from the China Environment Yearbook 2005-2011, we analyzed the water environment of the Huai River Basin, and changes in the water quality. According to the“Encyclopedia of Rivers and Lakes in China”(Huai River Basin section), we divided the river basin into five categories: upstream basin (upstream);midstream, north shore of the basin (midstream-north);midstream, south shore of the basin (midstream-south);downstream basin (downstream); and the Yishusi River Basin. To calculate the life expectancy and life expectancy after elimination of liver cancer in the study area, we used the Nemerow Pollution Index (NPI), to investigate the relationship between liver cancer and the water environment. Results Life expectancy in the 14 study districts varied from 68.99 years (Shenqiu County) to 78.85 years (Jinhu County). Gains in life expectancy after elimination of liver cancer varied from 0.86 to 0.31 years. Midstream-north showed the greatest improvement, with overall gain in life expectancy of 0.77 years;this gain was 1.04 years for males and 0.40 years for females. Yishusi River Basin showed the least improvement, with overall gain in life expectancy of 0.41 years;this gain was 0.54 years for males and 0.24 years for females. For the 7 years from 2004 to 2010, midstream-north had the highest annual NPI values, at 2.08, 1.74, 1.64, 1.81, 1.41, 1.26, and 1.06, respectively. There was a positive correlation between NPI and life expectancy gain for both males and females (r=0.64, P=0.014). There was positive correlation between NPI and life expectancy gain among males alone (r=0.64, P=0.014); there was no significant correlation between NPI and life expectancy gain among females (r=0.44, P=0.115). Conclusion Liver cancer had a significant impact on life expectancy in the Huai River Basin. The gain in life expectancy was higher for males than for females. There is a possible relationship between liver cancer deaths and the water environment in the research area, but this study did not infer a causal association.

Objective To investigate the relationship between liver cancer and the water environment, we analyzed the life expectancy in 14 counties (districts), which form the Huai River Basin with respect to liver cancer deaths in 2013 and changes in the surface water quality from 2004 to 2010. Methods The study area included the 14 counties (districts) of the Huai River Basin in China. We obtained surveillance data for all causes of death in the study area during 2013, as well as data for International Classification of Diseases,Tenth Edition(ICD-10) code C22 or liver cancer. Life expectancy and life expectancy after elimination of liver cancer were then calculated. Based on water quality monitoring data from the China Environment Yearbook 2005-2011, we analyzed the water environment of the Huai River Basin, and changes in the water quality. According to the“Encyclopedia of Rivers and Lakes in China”(Huai River Basin section), we divided the river basin into five categories: upstream basin (upstream);midstream, north shore of the basin (midstream-north);midstream, south shore of the basin (midstream-south);downstream basin (downstream); and the Yishusi River Basin. To calculate the life expectancy and life expectancy after elimination of liver cancer in the study area, we used the Nemerow Pollution Index (NPI), to investigate the relationship between liver cancer and the water environment. Results Life expectancy in the 14 study districts varied from 68.99 years (Shenqiu County) to 78.85 years (Jinhu County). Gains in life expectancy after elimination of liver cancer varied from 0.86 to 0.31 years. Midstream-north showed the greatest improvement, with overall gain in life expectancy of 0.77 years;this gain was 1.04 years for males and 0.40 years for females. Yishusi River Basin showed the least improvement, with overall gain in life expectancy of 0.41 years;this gain was 0.54 years for males and 0.24 years for females. For the 7 years from 2004 to 2010, midstream-north had the highest annual NPI values, at 2.08, 1.74, 1.64, 1.81, 1.41, 1.26, and 1.06, respectively. There was a positive correlation between NPI and life expectancy gain for both males and females (r=0.64, P=0.014). There was positive correlation between NPI and life expectancy gain among males alone (r=0.64, P=0.014); there was no significant correlation between NPI and life expectancy gain among females (r=0.44, P=0.115). Conclusion Liver cancer had a significant impact on life expectancy in the Huai River Basin. The gain in life expectancy was higher for males than for females. There is a possible relationship between liver cancer deaths and the water environment in the research area, but this study did not infer a causal association.

Objective To assess the reproducibility of long-term blood pressure variability in ischemic stroke and the association between the variability and cerebral microbleeds.Methods Patients with ischemic stroke at the previous 1-6 months were consecutively recruited and followed up 12-18 months.Blood pressure measurements were taken at every interview.Blood pressure variability indicated visit-to visit variability and was quantified by calculating the maximum ( Max),standard deviation (SD) and coefficient of variation (CV).For these variability might positively correlated with mean of blood pressure,the additional variability measure,SD independent of mean (SDIM),was also calculated.To determine the reproducibility of mean and variability measurements,the intraclass correlation (ICC) was also calculated.MRI was performed at baseline and the end of the study.Cerebral microbleeds were rated using Microbleed Anatomical Rating Scale (MARS).Multiple Logistic regression was used to assess the association between the visit-to-visit blood pressure variability and cerebral microbleeds.Results A total of 720 patients were recruited,of whom 595 (82.6％) subjects were present for 14 blood pressure readings during follow-up.The visit-to-visit blood variability measurements were moderately reproducible according to the ICC:0.46-0.72 for systolic blood pressure (SBP) and 0.42-0.69 for diastolic blood pressure ( DBP),respectively,P ＜0.01 for all measures.Patients with cerebral microbleeds were more likely to have higher mean blood pressure and variability for both SBP and DBP regardless the distribution of cerebral microbleeds.Being SBP Max,SBP SD,SBP CV,SBP SDIM(OR=1.036,95％ CI l.021-1.052,P=0.000; OR=1.060,95％CI 1.001-1.122,P =0.046; OR =1.084,95％ CI 1.000-1.175,P =0.049; OR =1.065,95％ CI 1.002-1.132,P =0.044) and DBP SD,DBP CV ( OR =1.111,95％ CI 1.000-1.233,P =0.049;OR =1.091,95％ CI 1.001-1.190,P =0.047) were the independently risk factors of cercbral microbleeds at deep region; SBP Max( OR =1.049,95％ CI 1.029-1.068,P =0.000) and DBP SD、DBP CV(OR =1.236,95％ CI 1.107-1.379,P=0.000;OR =1.188,95％ CI 1.087-1.298,P=0.000)independently associated with cerebral microbleeds at infratentorial location.There was no significant relation between the long-term variability of blood pressure and cerebral microbleeds at lobar region. Conclusions This study indicates that long-term blood pressure variability is substantial and independently associated with cerebral microbleeds in deep or infratentorial but not with that in lobar region.The different relations between the variability and cerebral microbleeds might indicate the heterogenic mechanisms of cerebral microbleeds.

Objective To observe the effect of traditional Chinese medicine internal and external treatment on chronic osteomyelitis.Method Chronic osteomyelitis experimental animal models were set up with debridement, then it was random divided into two groups ( antibiotics group for the control group, antibiotics and traditional Chinese medicine group for the observation group).After treatment for 10 days, new capillaries in the tissues surrounding sinus crossings were detected by pathological observation and VEGF expression was determined by ELISA.Result VEGF expression and vascular points of tissues surrounding sinus crossings of antibiotics with traditional Chinese medicine group were obviously higher than that of antibiotics group[ (47.48 ±3.22) μg/ml vs (28.26 ±2.61)μg/ml, P ＜0.01;8.03 ±1.73 vs5.17 ±2.89, P＜0.05 ].Conclusion Traditional Chinese medicine internal and external treatment can improve VEGF expression and increase capillary number inside tissues surrounding sinus.crossings , thus it can promote the healing of chronic osteomyelitis.

OBJECTIVE To study the risk factors and protection measures for the occupational exposure to HBV,and reduce the occupational exposure risk of blood.METHODS A survey was carried out among 1352 medical staff.And then we carried on the analysis to 43 questions of it and used Logistic regression analytic method to find out the risk factors and protective measures.RESULTS Seventy one persons had occuptional exposure risk to HBV and 56 persons had needle puncture wound or sharp wound.The risk factors included needle puncture wound or sharp wound,blood contaminated skin and mucous membrane,and the long working life.While knowledge of infection control,protection consciousness,washing hands,using gloves,and wearing glasses were the protective factors.CONCLUSIONS It plays the vital role to reduce occupational exposure to HBV that the medical staff should reduce injury in work,vaccinate the HBV vaccine,use protection goods and raise the protection consciousness.