Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.

Objective:To explore the in vitro antibacterial effects of low-intensity pulsed ultrasound (LIPUS) combined with 3.5 g/L povidone iodine solution on the biofilm of methicillin-resistant staphylococcus aureus (MRSA). Methods:Immature (cultured for 24 hours) and mature (cultured for 72 hours) MRSA biofilms were established on the surfaces of glass slides or confocal dishes. They were randomly divided into 4 groups ( n=9) according to different intervention methods. In the control group, glass slides or confocal dishes were placed in 500 mL of physiological saline for 3 minutes; in the PI group, glass slides or confocal dishes were placed in 500 mL of 3.5 g/L povidone iodine solution for 3 minutes; in the LIPUS group, glass slides or confocal dishes were placed in 500 mL of physiological saline and simultaneously intervened with LIPUS for 3 minutes; in the LIPUS & PI group, glass slides or confocal dishes were placed into 500 mL of 3.5 g/L povidone iodine solution and simultaneously intervened with LIPUS for 3 minutes. After intervention, confocal microscopy (CLSM) and scanning electron microscopy (SEM) were used to observe and compare the structure, morphology, bacterial survival, and viable cell count of the MRSA biofilms among the 4 groups. Results:On the MRSA biofilms cultured for 24 and 72 hours, CLSM and SEM observed sparse biofilms in the LIPUS group and LIPUS & PI group, and also a large number of dead bacteria in the LIPUS & PI group. On the MRSA biofilms cultured for 24 hours, the bacterial colony counts in the control group, PI group, LIPUS group, and LIPUS & PI group were (1.21±0.45)×10 6 CFU/mL, (3.38±2.81)×10 3 CFU/mL, (1.82±0.37)×10 3 CFU/mL, and (69.67±27.93) CFU/mL, respectively. Except for the comparison between PI group and LIPUS group, which showed no statistically significant difference ( P>0.05), there were statistically significant differences between the other groups when compared pairwise ( P<0.05). On the MRSA biofilms cultured for 72 hours, the bacterial colony counts in the control group, PI group, LIPUS group, and LIPUS & PI group were (3.01±0.70)×10 6 CFU/mL, (1.80±1.52)×10 5 CFU/mL, (2.10±0.52)×10 3 CFU/mL, and (68.67±19.55) CFU/mL, respectively. There were statistically significant differences between the 4 groups when compared pairwise ( P<0.05). Conclusions:Application of LIPUS or 3.5 g/L povidone iodine alone for 3 minutes on the immature or mature MRSA biofilms in vitro only leads to partial antibacterial activity. However, LIPUS can enhance the in vitro antibacterial effect of 3.5 g/L povidone iodine on the MRSA biofilms at different maturity levels.

Objective:To explore the mechanism of Huangqi Jiedu Decoction (HQJD) in the treatment of breast cancer with the syndrome of Zheng deficiency and toxic incandescence by network pharmacology and molecular docking technology.Methods:The main active ingredients and targets of HQJD were screened through the traditional Chinese medicine (TCM) systematic pharmacology database and analysis platform. The relevant targets of breast cancer with the syndrome of Zheng-deficiency, toxic-incandescence were obtained using OMIM, GeneGards and Drugbank databases, and the relevant targets of HQJD for the treatment of breast cancer with the syndrome of Zheng-deficiency and toxic incandescence were obtained by intersection; The Cytoscape 3.9.1 software was used to build the protein protein interaction (PPI) network and the " drug active component target disease" network on the basis of String 11.0 database, and the core active components and core targets of HQJD in treating breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence were inferred according to the topological parameters. gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on core targets using R language; and molecular docking verification on the main active ingredients and core targets were conducted.Results:230 effective targets of active ingredients of HQJD were screened, and 15 467 active ingredients of breast cancer with syndrome of Zheng-deficiency/toxic-incandescence were obtained; 217 intersection targets; GO function enrichment analysis showed that the treatment of HQJD for breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence mainly involved oxidative stress and cytochemical stress; The enrichment analysis of KEGG pathway showed that HQJD treatment of breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence was mainly related to phosphatidylinositol 3-protein kinase B (PI3K-Akt), interleukin-17 (IL-17) and other signal pathways. The molecular docking results showed that the main active ingredients such as β-sitosterol, stigmasterol, luteolin had good binding ability with core targets.Conclusions:HQJD has the characteristics of multi-component, multi target and multi pathway in the treatment of breast cancer with syndrome of Zheng-deficiency and toxic-incandescence, and its main mechanism may be related to PI3K-Akt, IL-17, P53 and other signal pathways.

Background Non-suicidal self-injury(NSSI)behavior has become a major public health concern and can have significant implications for the physical and mental health of adolescents.Peer victimization is a risk factor for adolesents to have NSSI behavior,so exploring the relationship and underlying mechanism between peer victimization and NSSI functions will provide a promising strategy for the prevention and intervention of NSSI behavior.Objective To investigate the relationship between peer victimization and NSSI functions in adolescents with unipolar and bipolar depression,so as to provide references for the intervention of NSSI behavior in adolescent patients with unipolar and bipolar depression.Methods Using multi-stage stratified sampling,940 adolescents with unipolar and bipolar depression who met the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria for bipolar depressive episodes or depressive disorders were selected from 14 psychiatric hospitals in China.All participations were assessed using Chinese version of the Functional Assessment of Self-Mutilation(C-FASM),Multidimensional Peer-Victimization Scale(MPVS),UCLA Loneliness Scale(UCLA-LS)and Patient Health Questionnaire-9 item(PHQ-9).Pearson correlation coefficient was to assess the correlation among above scales,and the model fit and path coefficients for mediation were analyzed with model 4 in Process 4.0 for SPSS.Results A total of 698(74.26%)adolescents with unipolar and bipolar depression completed the questionnaire survey.NSSI behavior was detected in 374 patients(53.58%).Among adolescents with unipolar and bipolar depression and NSSI behavior,MPVS total score was positively correlated with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.104,0.130,0.266,P<0.05 or 0.01),UCLA-LS score also yielded a positive correlation with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.321,0.112,0.246,P<0.05 or 0.01),and UCLA-LS score was positively correlated with MPVS total score(r=0.241,P<0.01).Loneliness demonstrated a complete mediating role in the relationship between peer victimization and emotion regulation function,with an indirect effect value of 0.033(95%CI:0.019～0.050)and an effect size of 73.33%.A partial mediating effect of loneliness was also observed for the relationship between peer victimization and social avoidance function,with an indirect effect value of 0.016(95%CI:0.007～0.025)and an effect size of 17.98%.Conclusion Loneliness may act as a mediator in the relationship between the peer victimization and the NISS emotion regulation and social avoidance functions in adolescents with unipolar and bipolar depression and NSSI behaviors.

Objective:To evaluate the clinical efficacy of single-stage total hip arthroplasty (THA) combined with intra-articular antibiotic injection in managing postoperative infections following internal fixation of hip fractures.Methods:A retrospective analysis was conducted on 25 patients who underwent single-stage THA for infection following internal fixation of hip fractures from January 2013 to January 2021 at the Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University. The cohort comprised 15 males and 10 females, with an average age of 61.52±13.06 years (range, 32-89 years) and an average body mass index of 24.04±3.84 kg/m 2 (range, 18-34 kg/m 2). The fractures included 13 femoral neck fractures, 6 intertrochanteric fractures, 4 acetabular fractures, 1 proximal femoral fracture, and 1 combined acetabular and intertrochanteric fracture. Preoperative joint cavity puncture or intraoperative joint fluid extraction, biochemical analysis, microbial culture, and drug sensitivity tests were performed. During surgery, infected internal fixation devices were removed, and hip prostheses were implanted following thorough debridement. Postoperatively, patients received intravenous and intra-articular sensitive antibiotics based on bacterial culture and drug sensitivity results. Joint stability was evaluated according to the Engh standard, and hip function was assessed using the Harris score. Results:Microbial cultures were positive in 12 cases, identifying Staphylococcus epidermidis (4 cases), Staphylococcus aureus (2 cases), Escherichia coli (2 cases), Enterobacter cloacae (1 case), Pseudomonas aeruginosa (1 case), Corynebacterium striatum (1 case), and a mixed infection of Staphylococcus epidermidis and Enterococcus faecalis (1 case). All 25 patients were followed for an average of 56.64±26.38 months (range, 24-123 months). Intravenous and intra-articular antibiotic treatment was administered to all patients. One case experienced sinus tract formation and pus discharge on the 20th postoperative day, diagnosed as periprosthetic infection, resulting in treatment failure, yielding an infection control rate of 96% (24/25). All patients demonstrated stable prosthesis fixation with no subsidence, loosening, or osteolysis. At the final follow-up, the Harris hip score improved significantly from a preoperative score of 26.69±13.47 to 92.30±5.60 ( t=22.882, P<0.001). Complications included 2 cases of hip dislocation, 2 cases of deep venous thrombosis in the lower extremities, 1 case of poor wound healing, and 1 case of periprosthetic fracture. Conclusion:Single-stage THA combined with intra-articular antibiotic injection is effective in controlling infections following internal fixation of hip fractures. This approach not only achieves a high infection control rate but also reconstructs hip joint function, resulting in satisfactory postoperative outcomes.

Objective:To explore the impact of stress perception on depression and the potential mediating role of resilience in medical staff.Methods:A total of 606 medical staff were recruited and investigated by self-designed questionnaire, the perceived stress scale (PSS-10), the 10-item Connor-Davidson resilience scale (CD-RISC-10), and the patient health questionnaire-9 (PHQ-9) from February to March, 2020.SPSS 26.0 software was used to execute Pearson or Spearman correlation analysis, common method biases test, and multicollinearity test.Model 4 in PROCESS 3.2 macro program and Bootstrap method were used for mediating effects analysis.Results:There was a positive correlation between stress perception score(16.93±6.65) and depression score (5.00(2.00, 9.00))( r=0.551, P<0.01), and a negative correlation between stress perception score and resilience score (27.08±8.68) ( r=-0.285, P<0.01) among 606 medical staff.There was a negative correlation between resilience score and depression score ( r=-0.474, P<0.01). Mesometric effect examination showed that resilience played a partial mediating role in the relationship between stress perception and depression, and the mediating effect accounted for 10.87% of the total effect. Conclusion:Stress perception can directly or indirectly influence depression scores, and resilience partially mediates the relationship between stress perception and depression.Depression can be reduced clinically by reducing stress perception or enhancing the resilience of medical personnel.

Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.

Objective:To investigate the efficacy of arthroscopic reduction and double-tunnel button fixation in the treatment of fractures of the tibial intercondylar eminence in children.Methods:From January 2019 to June 2022, 8 children with fracture of the tibial intercondylar eminence were treated at Orthopedics Department, Shenzhen Children's Hospital with arthroscopic reduction and double-tunnel button fixation. They were 6 boys and 2 girls, with an age of (8.4±1.9) years. Injured sites: 4 left knees and 4 right knees. Their operation time, intraoperative blood loss, knee flexion and extension, and complications were recorded. Their Lysholm scores were compared between preoperation and the last follow-up.Results:The operation time was (161.9±57.9)min. All patients were followed up for (12.1±5.7) months. The intraoperative blood loss was 3.5 (1.0,4.3)mL. Their knee flexion was 145.0°±5.0° and extension 0.9°±1.2° after operation. All their incisions healed at one stage, with no postoperative infection or other complications. Their preoperative Lysholm score [(20.3±15.8) points (from 2 to 54 points)] increased significantly to (99.3±1.0) points (from 98 to 100 points) after operation ( P<0.05). Conclusions:Arthroscopic reduction and double-tunnel button fixation is effective for fractures of the tibial intercondylar eminence in children, leading to limited complications, limited bleeding and a low infection rate.

Objective:To investigate the value of delta radiomics based on longitudinal changes of dynamic contrast enhanced MRI (DCE-MRI) in predicting pathological complete response (pCR) after neoadjuvant therapy (NAT) for breast cancer.Methods:The clinicopathological and imaging data of 117 patients with breast cancer confirmed by surgical pathology from April 2019 to November 2021 at Jiangxi Cancer Hospital were analyzed retrospectively. All patients were female with 23?74 (48±10) years old. The patients were randomly divided into training (81 cases) and test sets (36 cases) at the ratio of 7∶3 according to the number of random seeds in the software. All patients underwent DCE-MRI before and after early NAT (2 courses). The maximum diameter relative regression value of breast tumors before and after early NAT (D%) was calculated and used to construct a conventional imaging model. The delta radiomic features were extracted based on pre-NAT and early-NAT (2 courses) DCE-MRI and selected by redundancy analysis and least absolute shrinkage and selection operator algorithm. A ten-fold cross-validation method was used to construct the delta radiomic model and Radscore was calculated for each patient. All patients were classified into pCR group and non-pCR group according to the surgical pathology after NAT. Significant clinicopathological variables were selected by univariate analysis and stepwise regression method. They were integrated with D% and Radscore to build the combined model and nomogram. The model performance in predicting pCR after NAT in breast cancer was evaluated by the receiver operating characteristic curve and the area under the curve (AUC), and the clinical utility of the models was compared by using clinical decision curves.Results:The combined model had the best diagnostic performance among the three models, with an AUC of 0.90 in the training set and 0.87 in the test set. The Radscore had the highest weight in the nomogram. In the training set, the diagnostic performance of the combined model and delta radiomics model were better than that of the conventional imaging model ( Z=?3.48, P=0.001; Z=2.54, P=0.011). The clinical decision curves showed an overall greater clinical benefit of the combined model compared with the conventional imaging model and delta radiomic model. Conclusions:The addition of significant clinicopathological variables and Radscore of delta radiomic model which represents the longitudinal changes in tumor heterogeneity to the conventional imaging model may improve the predictive ability of pCR. The delta radiomic may serve as a noninvasive biomarker for early prediction of NAT response.

Objective:To investigate the risk factors for acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and to construct its nomogram.Methods:Clinical data of patients who underwent ERCP for common bile duct stones in the First Hospital of Lanzhou University from January 2014 to December 2019 were retrospectively analyzed. A total of 95 patients with acute cholangitis after the operation (the acute cholangitis group) were included and 285 patients without acute cholangitis after the operation (the non-acute cholangitis group) were selected by random sampling at 1∶3 via the software. Logistic regression analysis was used to evaluate the risk factors for acute cholangitis after ERCP. A nomogram model was established to predict the incidence of acute cholangitis after ERCP based on the results of multivariate analysis.Results:Univariate analysis showed that there were significant differences in age, combination with diabetes, levels of alanine aminotransferase, alkaline phosphatase and glucose, roughness in gallbladder wall, bile duct diameter, stenosis in lower bile duct, proportion of patients who underwent endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage between the two groups ( P<0.05). Logistic multivariate regression analysis showed that advanced age ( OR=1.108, 95% CI:1.079-1.138, P<0.001), combination with diabetes ( OR=4.524, 95% CI:1.299-15.758, P=0.018), roughness in gallbladder wall ( OR=2.495, 95% CI:1.106-5.630, P=0.028), increased bile duct diameter ( OR=1.303, 95% CI:1.181-1.437, P<0.001), and stenosis in lower bile duct ( OR=4.192, 95% CI:2.508-7.005, P<0.001) were independent risk factors for acute cholangitis after ERCP. Based on the results of multivariate analysis, the nomogram of acute cholangitis after ERCP was established. The area under the receiver operator characteristic curve was 0.887. Conclusion:Advanced age, combination with diabetes, rough gallbladder wall, increased diameter of bile duct and stenosis in lower bile duct are independent risk factors for acute cholangitis after ERCP. Clinicians can make clinical intervention based on the nomogram of risk factors above to improve the prognosis of patients.