BACKGROUND: The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR). METHODS: A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS. RESULTS: DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2 = 19.57, P <0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS ( χ2 = 17.08, P <0.05). The RTS rate was influenced by SNQs of the graft's tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test ( χ2 = 13.49, P <0.01), objective IKDC-2000 ( χ2 = 27.02, P = 0.002), and anterior instability test ( χ2 = 9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57 ± 7.72, CASBR: 83.00 ± 12.71, ASBR: 83.21 ± 11.95; F = 10.452, P <0.01) and IKDC-2000 score (DBR: 90.95 ± 7.00, CASBR: 84.64 ± 12.68, ASBR: 83.63 ± 11.41; F = 11.78, P <0.01). CONCLUSION: For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS. TRIAL REGISTRATION ClinicalTrials.gov (NCT05400460).
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Male ; Female ; Adult ; Anterior Cruciate Ligament Injuries/surgery* ; Young Adult ; Return to Sport ; Adolescent ; Anterior Cruciate Ligament/surgery* ; Treatment Outcome

Malignant melanoma is an extremely aggressive tumor that can be surgically treated in its early stage.In advanced stages,the invasive and proliferative capabilities of melanoma cells continue to increase,and traditional treatment methods such as radiotherapy,chemotherapy,and immunotherapy have limited efficacy,resulting in poor patient prognosis.Due to the presence of mutations in multiple molecular pathways in malignant melanoma,targeted therapy is now regarded as a more viable treatment option for patients with advanced malignant melanoma,with most patients benefiting from it.However,the development of drug resistance to targeted therapy has always been a serious challenge,as the emergence of resistance limits the efficacy.Therefore,it is necessary to explore the mechanism and drug resistance of targeted therapy of malignant melanoma.

Animals ; Macaca mulatta ; Optic Disk ; Glaucoma ; Craniocerebral Trauma ; Intraocular Pressure ; Low Tension Glaucoma

Objective To explore the prevention and treatment of vasovagal reflex during and after operation in diseases of urinary system.Methods From February 2020 to April 2023,1436 patients who completed inpatient surgery in Department of Urology,Songshan Hospital,Qingdao University Medical College were selected to analyze the emergency management measures of vasovagal reflex during and after operation and summarize the diagnosis and treatment experience.Results Among 1436 patients,vasovagal reflex occurred in 4 cases during operation and 14 cases after operation,with an incidence of 1.25%.Most patients showed simultaneous decrease in blood pressure and heart rate.After intravenous injection of atropine and dopamine,blood pressure and heart rate returned to normal,and various concomitant symptoms disappeared,and no death cases were reported.Conclusion Urological specialists should pay attention to vasovagal reflex,sum up experience,do early identification,timely treatment to ensure the safety of patients.

Background and aims:Hepatocellular carcinoma(HCC),which is prevalent worldwide and has a high mortality rate,needs to be effectively diagnosed.We aimed to evaluate the significance of plasma microRNA-15a/16-1(miR-15a/16)as a biomarker of hepatitis B virus-related HCC(HBV-HCC)using the machine learning model.This study was the first large-scale investigation of these two miRNAs in HCC plasma samples. Methods:Using quantitative polymerase chain reaction,we measured the plasma miR-15a/16 levels in a total of 766 participants,including 74 healthy controls,335 with chronic hepatitis B(CHB),47 with compensated liver cirrhosis,and 310 with HBV-HCC.The diagnostic performance of miR-15a/16 was examined using a machine learning model and compared with that of alpha-fetoprotein(AFP).Lastly,to validate the diagnostic efficiency of miR-15a/16,we performed pseudotemporal sorting of the samples to simulate progression from CHB to HCC. Results:Plasma miR-15a/16 was significantly decreased in HCC than in all control groups(P＜0.05 for all).In the training cohort,the area under the receiver operating characteristic curve(AUC),sensitivity,and average precision(AP)for the detection of HCC were higher for miR-15a(AUC=0.80,67.3％,AP=0.80)and miR-16(AUC=0.83,79.0％,AP=0.83)than for AFP(AUC=0.74,61.7％,AP=0.72).Combining miR-15a/16 with AFP increased the AUC to 0.86(sensitivity 85.9％)and the AP to 0.85 and was significantly superior to the other markers in this study(P＜0.05 for all),as further demonstrated by the detection error tradeoff curves.Moreover,miR-15a/16 impressively showed potent diagnostic power in early-stage,small-tumor,and AFP-negative HCC.A validation cohort confirmed these results.Lastly,the simulated follow-up of patients further validated the diagnostic efficiency of miR-15a/16. Conclusions:We developed and validated a plasma miR-15a/16-based machine learning model,which exhibited better diagnostic performance for the early diagnosis of HCC compared to that of AFP.

Purpose To investigating the pathological characteristics of the heart and spleen in a Kawasaki disease(KD)model induced by candida albicans watersoluble fraction(CAWS)and to provide a research basis for the pathological mechanisms of KD.Methods Intraperitoneal injection of CAWS was used to establish a KD model in C57BL/6 mice.Specimens of the heart,aorta,and spleen were collected to measure body weight and the weights of the heart and spleen.HE staining was utilized to examine the morphological alterations in the heart,aorta,and spleen.The expression levels of the ma-ture macrophage marker(F4/80),TNF-α,and IL-1β in the spleen were measured using qRT-PCR and immunofluorescence.its clinical pathological characteristics were analyze and relevant literatures were reviewed.Results Compared to the control group,there were no significant differences in the heart and body mass of the model group mice,but their spleen mass signif-icantly increased(P＜0.05).In the myocardial interstitium of model group mice,there was infiltration of mononuclear cells,disorder of the elastic fibers in the aortic wall along with mucoid degeneration,disruption of the splenic red and white pulp struc-ture,and significant macrophage infiltration.In the model group mice,the mRNA levels and immunofluorescence staining inten-sity of spleen F4/80(2.58-fold,P＜0.000 1),TNF-α(1.43-fold,P＜0.001),and IL-1β(3.62-fold,P＜0.000 1)were significantly higher than those in the control group.Conclusion Mice with KD models induced by CAWS can exhibit patholog-ical alterations akin to KD in the heart and aorta,significant en-largement of the spleen,infiltration by macrophages,with ele-vated expressions of TNF-α and IL-1β.

Dexmedetomidine,which is an α2 adrenergic receptor agonist with sedative,analgesic,anxiolytic and anti-sympathetic effects,has become a widely used drug in clinical anesthesia and intensive care unit(ICU).Compared with other drugs in the department of anesthesiology,dexmedetomidine has no obvious respiratory depression and no obvious hemodynamic changes,and can significantly reduce the dosage of sedative and analgesic drugs when combined with other anesthetics.In clinical applications,dexmedetomidine has been found to induce a sedative response that is associated with rapid arousal.Dexmedetomidine is traditionally thought to act through α2 adrenergic receptors to lower blood pressure,dilate blood vessels and lower heart rate,but it is unclear how it affects neural circuits in the brain.In recent years,there has been an increasing number of studies on the mechanism of action of dexmedetomidine,which has confirmed that the ventrolateral preoptic nucleus(VLPO),locus coeruleus(LC)and ventral tegmental area(VTA)of the hypothalamus are involved in the sedation mediated by dexmedetomidine,the dorsal root ganglion(DRG)and superior cervical ganglion(SCG)are involved in dexmedetomidine-mediated analgesia,and the hypothalamic preoptic area(PO)and hypothalamic paraventricular nucleus(PVN)are involved in the changes in body temperature and water-electrolyte balance mediated by dexmedetomidine,providing a new direction for understanding the mechanism of dexmedetomidine in the central nervous system.

Objective To explore the predictive value of enhanced magnetic resonance imaging (MRI) for pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation. Methods Clinical materials of 105 patients with conservative treatment for lumbar disc herniation in the hospital from September 2021 to September 2022 were retrospectively analyzed. All the patients underwent enhanced MRI at the time points of hospital admission and the final examination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of enhanced MRI parameters [maximal rim thickness (Tr), rim enhancement range (Er), and herniated volume] in the pathological classification of lumbar disc herniation. Patients were followed up for 8 months and divided into recurrence and non-recurrence groups based on recurrence after conservative treatment. The Oswestry Disability Index (ODI) score, the Visual Analogue Scale (VAS) score for low back pain, and levels of enhanced MRI parameters were compared between the two groups. ROC curve analysis was conducted to assess the predictive value of Tr, Er and herniated volume for the prognosis. Results The levels of Tr and Er in the extrusion patients were significantly higher than those in the sequestration patients (P < 0.05). The area under the curve (AUC) for the prediction of pathological classification of lumbar disc herniation by Tr combined with Er was 0.854, with a sensitivity of 84.21% and a specificity of 76.12%. After treatment, the ODI score and VAS score for low back pain in the non-recurrence group were significantly lower than those in the recurrence group, while Tr and Er were significantly higher in the non-recurrence group (P < 0.05).The AUC for the prediction of the prognosis of conservative treatment for lumbar disc herniation by Tr combined with Er was 0.802, with a sensitivity of 96.55% and a specificity of 53.95%. Conclusion Enhanced MRI has good value in assessing the pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation.

In recent years,endovascular intervention therapy has gained popularity due to its advantages of minimal trauma and quick recovery,and become an essential method for treating cerebrovascular diseases.As a crucial surgical instrument in interventional therapy,catheters often require precise control of their tips to navigate through tortuous positions.Traditional catheters have shortages of fixed tip shapes,limited proximal torque transmission,and difficulty of manipulation,increasing the risk of complications during interventional procedures and prolonging surgical exposure time.With the rapid development of materials science and engineering,steerable catheter systems have become the spotlight of interventional physicians,making precise"bend control"possible.This article systematically explained the classification of steerable catheter systems,focusing on their application in neurointerventional therapy,and provided an outlook on the future development of steerable catheters.