ObjectiveTo investigate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength and walking for patients after anterior cruciate ligament reconstruction (ACLR). MethodsThirty-four patients after ACLR were selected at Beijing Rehabilitation Hospital of Capital Medical University from July, 2022 to October, 2023, and randomly divided into control group (n = 17) and experimental group (n = 17). Both groups received routine rehabilitation and functional training, and the experimental group received NMES during the functional training, while the control group received sham NMES, for eight weeks. Quadriceps peak torque-to-weight ratio, single-leg support phase and plantar impulses during walking were measured before and after intervention. ResultsTwo cases in the control group and three in the experimental group dropped down. Quadriceps peak torque-to-weight ratio improved in both groups after intervention (|t| > 17.578, P < 0.001), and improved more in the experimental group than in the control group (t = 4.714, P < 0.001); while the affected single-leg support phase and the affected/unaffected single-leg support phase ratio improved in both groups (|t| > 16.882, P < 0.001), and improved more in the experimental group than in the control group (t > 3.234, P < 0.01); and plantar impulses of all zones optimized in both groups (t > 9.221, P < 0.001), and were better in the experimental group than in the control group(|t| > 2.852, P < 0.01). ConclusionNMES may further improve quadriceps muscle strength, plantar pressure distribution during walking and single-leg support in patients after ACLR.

Objective To investigate the effect of daily soft brace wearing on plantar dynamics during walking in patients with chronic ankle instability(CAI). Methods A total of 52 patients with unilateral chronic ankle instability(CAI)in Beijing Rehabilitation Hospital from February,2021 to January,2023 were randomly divided into control group(n=26)and experimental group(n=26).Both groups underwent an eight-week exercise training program.The control group wore placebo brace dur-ing daily activities,while the experimental group wore soft ankle brace.Plantar dynamic parameters were mea-sured using a pressure plate system during walking,including peak plantar pressure and plantar impulse before and after intervention. Results Six participants dropped out in the control group and five in the experimental group,resulting in a final inclu-sion of 41 participants.After intervention,there was no significant difference in peak plantar pressure and im-pulse on the affected side in the control group among different areas(P＞0.05).In the experimental group,the peak pressure and impulse in the heel medial,heel lateral and forefoot medial areas increased(|t|＞4.192,P＜0.001),while the peak pressure and impulse in the midfoot and lateral forefoot areas decreased(t＞2.984,P＜0.05);the peak pressure and impulse in the heel medial,heel lateral and forefoot medial areas were higher in the experimental group than in the control group(|t|＞2.126,P＜0.05),and the peak pressure and impulse were low-er in the midfoot and forefoot lateral areas(t＞2.133,P＜0.05). Conclusion Wearing a soft brace during daily activities may optimize the distribution of peak plantar pressure and plan-tar impulse on the affected side in patients with CAI,which may prevent recurrence of sprains.

Percutaneous nephrolithotomy(PCNL) has always been the first-line minimally invasive treatment for staghorn kidney stones, with high surgical efficiency and first-stage stone free rate. However, due to the complexity of stones and the difficulty of surgery, serious complications such as postoperative bleeding, infection, and renal function damage often occur. Needle-perc assisted endoscopic surgery(NAES) surgery, also known as needle-perc assisted endoscopic surgery, is an innovative model based on needle-perc proposed by our center. The S+ N mode is standard tract PCNL combined with needle-perc, which not only improves the efficiency and stone free rate, but also reduces the number of tracts, effectively protecting renal function and reducing complications. This article reports a case of complete staghorn kidney stones that were completely removed by NAES surgery in one stage, with no complications after surgery and the patient recovering quickly and being discharged from the hospital.

Objective To determine the appropriate time to perform laparoscopic cholecystectomy(LC)for acute calculous cholecystitis.Methods The clinical data of 125 patients with acute calculous cholecystitis who underwent LC between Jan.2018 and Dec.2021 were retrospectively analyzed.According to the interval time from symptom onset to operation,all patients were divided into 2 groups:immediate group(43 cases)who underwent LC within 24 hours and delayed group(82 cases)who underwent LC in 25-72 h.The operation time,intraoperative blood loss,conversion to laparotomy,postoperative complications,postoperative hospitalization days and hospitalization expenses between the two groups were compared.Results The operation time,intraoperative blood loss of immediate group were lower than those of delayed group[50(45,65)min vs 65(55,95)min,10(10,20)ml vs 20(10,30)ml,P＜0.05].There were no significant differences between the two groups with respect to incision infection,bile leak and biliary duct injury(4.7％vs13.4％,2.3％vs 2.4％,2.3％vs 1.2％,P＞0.05),but the total rate of postoperative complications in immediate group reduced significantly(9.3％vs 29.3％,P＜0.05).No mortality occurred in either group.Both of postoperative hospitalization days and direct medical costs reduced in immediate group[5(5,7)d vs 7(6,7)d,6 503(6 231,7 749)yuan vs 7 056(6 448,9 105)yuan,P＜0.05].Conclusion LC for the operable patient with acute calculous cholecystitis,during 24 h from onset of symptom,significantly reduced the operation time,intraoperative blood loss and postoperative hospital stay without increasing the rate of bile leak and biliary duct injury.

Objective:To analyze the safety and efficacy of ultrasound-guided needle-perc assisted retrograde intrarenal surgery (RIRS) in the treatment of small but complex renal calculi, and summarize our clinical experience.Methods:The clinical data of 36 patients with small but complicated renal stones treated by ultrasound-guided needle-perc assisted RIRS in Beijing Tsinghua Changgung Hospital from January 2020 to April 2022, were retrospectively analyzed. There were 25 males and 11 females. The average age was (54.7±6.1) years, and the body mass index (BMI) was (26.3±3.1) kg/m 2. The maximum diameter of the calculi was (1.8±0.7) cm. There were 28 patients without renal hydronephrosis before operation, 8 patients with mild to moderate renal hydronephrosis, 4 patients with caliceal diverticular stones, 32 patients with lower pole stones, 10 patients with ureteral stones, 6 patients with previous surgical history of ipsilateral kidney stones, and 3 patients with stones in the solitary kidneys. Patients were placed in oblique supine lithotomy position or prone split leg position (female). For lower pole stones or diverticular stones that were difficult to be handled by flexible ureteroscope, the needle-perc was used to puncture the stones in target calyx under ultrasound guidance. Holmium laser was then used to pulverize or fragment the calculi, and the flexible ureteroscope was used to remove or further pulverize the stone fragments. Perioperative indexes and postoperative complications were recorded, and stone-free rate was analyzed. Results:All 36 cases were successfully operated. The median operation time was 61.5(59.0, 66.8)min, with a median decrease in hemoglobin on the first postoperative day of 1.6(0.8, 2.0)g/ L, a median postoperative hospital stay of 1.5(1.0, 2.0)days, and a median needle-perc tract of 1(1, 2). The complications were recorded in 4 patients (11.1%), all of which were Clavien-Dindo grade I, including postoperative fever in 2 patients and analgesic use in 2 patients. The primary stone-free rate was 83.3% (30/36). The 6 patients with residual stones were treated by external physical vibration lithecbole on the 3rd to 7th day after surgery. After 1 month follow-up, residual stone expulsion were seen in 3 patients. Three patients with residual stones were followed up regularly. The final stone-free rate was 91.7% (33/36).Conclusions:Ultrasound-guided needle-per assisted RIRS is safe and effective in the treatment of small but complex renal calculi, with high postoperative stone free rate and low complication rate.

Objective:To investigate clinical efficacy and safety of venetoclax (VEN)-based regimens in the treatment of acute myeloid leukemia (AML).Methods:The clinical data of 41 AML patients treated with venetoclax-based regimens from January 2021 to December 2021 in Ruijin Hospital North of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The treatment regimens included VEN+demethylating drugs ± gene mutation inhibitors or VEN+chemotherapy with a median number of 2 courses (1- 5 courses).Results:The median age of all patients was 60 years (18-73 years), and there were 24 males and 17 females. After 1 course of VEN-based therapy, 22 (53.7%) patients achieved complete remission (CR) or morphological complete remission without complete blood count recovery (CRi), including 5 patients achieving minimal residual disease (MRD) negative. After 2 courses of treatment, of 17 patients available for efficacy evaluation, 7 patients achieved MRD negative. Among 20 relapsed/refractory AML patients, 9 cases achieved CR/CRi after 1 course of treatment, of which 1 patient had MRD negative. Among 21 patients initially treated and re-treated, 13 cases achieved CR/CRi and 1 case achieved partial remission after 1 course of treatment, of which 4 cases had MRD negative.Conclusions:VEN-based treatment regimens for AML have a high remission rate and tolerable adverse effects.

Objective To observe the changes of invasion and migration patterns and integrin expression of malignant glioma cells when Rac and Rho pathways are suppressed,respectively,in 3D hydrogel.Methods Liposome mediated pCMVLifeAct-TagGFP2 plasmids were transfected into glioma U87 cells,and then,these cells were divided into NSC23766 treatment group,Y-27632 treatment group,NSC23766 and Y-27632 combined treatment group,and control group.The three treatment groups were added NSC23766 (100 nmol/mL),Y-27632 (10 nmol/mL),100 nmol/mL NSC23766 and 10 nmol/mL Y-27632,respectively;the cells in the control group were added the same amount of medium.Cells were cultured in hydrogel;the composition of round cells,spindle cells and the mesenchymal and amoeboid cell movement transition were observed under confocal microscopy.The hydrogels of each group were infused into the microslide,and the cell chemotaxis effect were recorded and the cell movement velocities and distances were calculated in the living cell workstation.Immunofluorescence was used to observe the alternation ofintegrin expression.Results U87 cells cultured in 3D hydrogel exhibited spindle-like and round-like shapes,corresponding to mesenchymal and amoeboid cell movement.As compared with that in the control group,the proportion of round cells in the NSC23766 treatment group was significantly higher,and that of spindle cells in the Y-27632 treatment group was significantly higher (P＜0.05).The conversion rate ofmesenchymal-amoeboid transition was 50.0％ in NSC23766 treatment group and amoeboid mesenchymal transition was 42.8％ in Y-27632 treatment group as compared with that in the control group,with significant differences (P＜0.05).The velocity and distance of cells cultured in 3D hydrogel decreased orderly in NSC23766 treatment group,control group,Y-27632 treatment group and combined treatment group in chemotaxis test.The immunofluorescence test showed that integrin expression in the Y-27632 treatment group was significantly higher than that in the other three groups,and that in the control group was statistically higher than that in the NSC23766 treatment group and combined treatment group (P＜0.05).Conclusions 3D hydrogel can be used as a favorable substrate for cell culture.The combination targeted inhabitation of Rac 1 and RohA pathways provides theoretical basis for anti-invasion treatment against glioma.

Objective To investigate the inhibitory effect of a disintegrin and metalloprotease 12 silenced by shR?NA on self-renewal capacity of CD133 positive giloma cells. Methods The shRNA recombinant lentivirus aimed at si?lencing ADAM12 was prepared. Human glioma cells U87 were employed in this study and assigned into three groups:shRNA-ADAM12, shRNA-NCandshRNA-C. ADAM12 expression was detected at mRNA and protein level using Re?al-time quantitative-PCR and western bloting, respectively. U87 cells were cultured with stem cell culture medium, to obtain cell sphere formation in which CD133 positive glioma cells were enriched. Immunofluorescence was employed to detect the expression of ADAM12 and CD133 in cell spheres and U87 cells; Self-renewal was tested by using tumor sphere formation assay. Molecular markers for differentiated or undifferentiated cells (CD133,GFAP and Tuj1) were de?tected at protein using western blotting. Western blotting was employed to test protein expression of HES1. Results AD?AM12 shRNA significantly down-regulated the mRNA and protein expression levels of ADAM12. Compared with shRNA–C group, the relative expression levels of mRNA in shRNA-ADAM12 group and shRNA-NC group were 0.22 ± 0.03 and 0.98 ± 0.06 (F=425.37,P<0.01). The relative expression levels of protein in shRNA-ADAM12 group, shRNA-NC group and shRNA-C group were 28.72%±2.36%, 69.21%±3.92%and 69.04%±3.57%, respectively (F=145.42,P<0.01). Immunofluorescence staining showed that expression levels of ADAM12 and CD133 in cell spheres were significantly higher than those in normal cells. The number of spheres in three groups were 45.5±2.3、104.2±5.8 and 109.6±6.2, tumor sphere formation ability of shRNA-ADAM12 group was lower than that of shRNA-NC group and shRNA-C group (F=147.03,P<0.01). Compared with the shRNA-NC group and shRNA-C group, the protain expression of GFAP and Tuj1 were increased up to 166% and 146% (P<0.01) whereas the protein expression levels of CD133 and HES1 were down-regulated by 54% and 50% (P<0.01). Conclusion Knockdown of ADAM12 may suppress self-renewal ability of CD133 positive glioma cells by inhibiting the Notch pathway activity.

Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.