Objective:To evaluate the effect of virtual reality arthroscopic simulation system combined with case-based learning (CBL) in orthopedic clinical teaching.Methods:From January 2021 to June 2022, a total of 36 residents who took the standardized residency training at Department of Articular Orthopedics in The Third Affiliated Hospital of Soochow University were enrolled in this study. They were randomized into an experimental group and a control group, with 18 trainees in each group. The experimental group adopted the virtual reality arthroscopic simulation system combined with CBL teaching mode, while the control group adopted simple endoscopic simulation training box with traditional teaching mode. Theoretical and practical tests and questionnaire survey were carried out to evaluate the teaching effects in two groups. SPSS 22.0 was performed to conduct t-test on the measurement data between the two groups. Results:The theoretical and practical test scores of the experimental group [(89.39±3.09) and (82.72±4.28)] were better than those of the control group [(86.22±4.43) and (76.61±5.65)], with statistically significant differences ( t= 2.49, P=0.018; t=3.66, P=0.001). The questionnaire survey showed that the experimental group was better than the control group in creating novel forms of courses [(4.94±0.24) vs. (4.11±0.58), t=5.62, P<0.001], simulating more real scenes [(4.83±0.38) vs. (3.78±0.43), t=7.80, P<0.001], inspiring learning interests [(4.78±0.43) vs. (4.00±0.59), t=4.51, P<0.001], improving practical skills [(4.83±0.38) vs. (3.83±0.51), t=6.61, P<0.001], and building career confidence [(4.50±0.62) vs. (3.06±0.54), t=7.47, P<0.001], with statistically significant differences (all P<0.001). Conclusions:The virtual reality arthroscopic simulation system combined with CBL teaching mode can better simulate the real clinical scenes, help inspire the interest of learning and quickly improve practical skills, thereby improving the effect of orthopedic clinical teaching.

Humans ; Proto-Oncogene Proteins p21(ras)/genetics* ; Prognosis ; Biomarkers, Tumor/genetics* ; Mutation/genetics* ; Colorectal Neoplasms/genetics* ; Proto-Oncogene Proteins B-raf/metabolism*

OBJECTIVES: To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). METHODS: A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. RESULTS: There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. CONCLUSIONS Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.
Amniotic Fluid ; Humans ; Infant ; Infant, Newborn ; Intubation, Intratracheal ; Meconium ; Meconium Aspiration Syndrome/therapy* ; Retrospective Studies ; Suction

Anti-contactin-1(CNTN1) IgG4 antibody is a reliable biomarker of a specific subset of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with distinct clinical features, including advanced age, aggressive symptom, predominantly motor involvement, sensory ataxia, and poor response to intravenous immunoglobulin. Nerve conduction study showed decrease of nerve conduction velocity, reduction of compound motor active potential amplitude without temporal dispersion at early stage of the disease. The article reported an anti-CNTN1 IgG4 antibody positive case, reviewed the current relevant literature, and then summarized the clinical characteristics of anti-CNTN1 IgG4 antibody associated CIDP.

Objective: To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index. Methods: From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients. Results: Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) . Conclusion A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.

Objective To investigate the correlation between plasma homocysteine level and impaired glucose tolerance(IGT) patients in peripheral neuropathy.Methods 80 patients with IGT were selected according to the results of routine nerve conduction test,including 40 patients associated with peripheral neuropathy (IGT-PN),and 40 patients without peripheral neuropathy (IGT-NPN).Besides,40 healthy subjects were selected as control.Plasma homocysteine levels were measured in the three groups by enzyme rate method.The severity of neuropathy was scored and graded by the Toronto Clinical Scoring System (TCSS).Results Plasma homocysteine levels were significantly higher in the all IGT groups than those in the control group.The plasma homocysteine level in the IGT-PN group (14.2±2.7) μmol/L was significantly higher than that in the IGT-NPN group (12.3±2.6) μmol/L (P＜0.05).Regression analysis showed that plasma homocysteine level had independent effects on IGT with peripheral neuropathy.Plasma homocysteine level was positively correlated with TCSS score.Conclusions Plasma homocysteine may play an important role in the pathogenesis of peripheral neuropathy in patients with IGT,and their level may be associated with the severity of peripheral neuropathy.

Early diagnosis of prediabetic peripheral neuropathy depends on the evaluation of small fibers.Traditional nerve conduction tests can only evaluate the function of large myelinated fibers,while lack of sensitivity to small fibrous lesions.These lesions were related to pain and autonomic neuropathy.In recent years,with the progress of neurophysiological diagnosis technology,the early diagnosis of diabetic peripheral neuropathy has been improved.Clinical methods,commonly used in the detection of small fibrous lesions,mainly include skin sympathetic response,quantitative sensory test,contact heat pain evoked potential,and quantitative sudomotor axonal reflex test.In this paper,the pathogenesis of diabetic peripheral neuropathy,neurological pathological changes and applications of electrophysiology technology were reviewed to provide an objective basis for early diagnosis of prediabetic peripheral neuropathy.

This study retrospectively reviewed 75 patients with impaired glucose tolerance(IGT)admitted in our hospital from March 2015 to October 2015.All patients underwent Toronto clinical scoring system(TCSS) evaluation.Patients with IGT were further divided into normal score group(TCSS-N, n=50)and abnormal score group(TCSS-A, n=25)according to their scoring results, and 30 healthy volunteers were served as control group.All patients and controls underwent motor and sensory nerve conduction studies, as well as sympathetic skin response(SSR)test using the Keypoint.Net(Medoc Ltd)electromyogram device.The results showed that the SSR amplitude of lower limbs was reduced [(0.61±0.44 vs 1.00±0.33)mv, P<0.05]andlatencyoflowerlimbswas extended [(1 880±282 vs 1 642±256)ms, P<0.05]in IGT group compared with control group.But median, ulnar, tibial, and peroneal nerve sensory and motor conduction revealed no difference between two groups.In TCSS-A group, the SSR amplitude of lower limbs was reduced [(0.47±0.39)mv, P<0.05], latency of lower limbs was extended [(2 062±291)ms,P<0.05]and the sensory nerve action potential(SNAP)amplitude of the tibial nerve was significantly lower compared with control group [(1.83±0.37 vs 2.07±0.30)μv, P<0.05].Compared to TCSS-N group, latency of lower limbs was extended [(2 062±291 vs 1 808±246)ms, P<0.05]in TCSS-A group.The SSR amplitude of lower limbs were reduced[(0.66±0.44)mv,P<0.05]and latency were prolonged(P<0.05)in TCSS-N group compared with control group.Pearson correlation analysis showed that the SSR amplitude and latency of the lower limbs were correlated with the postprandial blood glucose, blood glucose fluctuation, body weight, as well as body mass index.These results suggest that there exists peripheral nerve damage in the patients with IGT, mainly involving the small fiber nerve of the lower limbs.Large fibers may also be mildly affected as the disease progresses.

Objective To investigate the correlation between epicardial fat thickness and non dipper hypertension.Methods A total of 150 subjects was included in the study,of which 50 were in the non dipper hypertension group,the same in the non dipper hypertension group and the healthy control group.History collection and routine laboratory tests,ultrasonic measurement of epicardial fat thickness,and 24 hour ambulatory blood pressure monitoring were carried on all subjects.Epicardial fat thickness between groups was compared to primarily analyze the correlation of epicardial fat thickness and non dipper type hypertension.The optimal screening positive value in epicardial fat thickness of non dipper type primary hypertension was obtained by receiver operating characteristic (ROC) curve and maximum Youden index.Results When non dipper hypertension group and non-dipper hypertension group were compared,epicardial fat thickness was significantly increased [(6.30 ± 0.94) mm vs (5.92 ± 0.75) mm,P ＜ 0.05],as compared dipper hypertension group to healthy group,the epicardial fat thickness was significantly increased [(5.92 ±0.75)mm vs (5.50 ±0.13)mm,P ＜0.05].Epicardial fat thickness and non dipper type primary hypertension were linearly related (r =0.43,P ＜ 0.05),and epicardial fat thickness in diagnosis of non dippers primary hypertension optimal screening positive value was 6.01 mm.Conclusions There is a close relationship of epicardial fat thickness and non dipper hypertension.

Objective To investigate the clinical and imaging features of pseudo subarachnoid hemorrhage(pseudo-SAH) in order to provide a theoretical basis for correct diagnosis and reducing misdiagnosis.Methods The clinical and imaging data of 5 patients with pseudo-SAH were retrospectively analyzed and summarized.Results Five pseudo-SAH patients had a history of unconsciousness,respiratory disorder,mechanical ventilation,hypoxemia and acidosis.Cranial CT showed diffuse cerebral edema and high density of cerebral fissure and cerebral ventricle,and there was no bloody cerebrospinal fluid via lumbar puncture.In the five patients,one improved,three died,and one gave up treating because of invalid treatment.Conclusions All patients have a history of hypoxic-ischemic encephalopathy before onset of pseudo-SAH.The clinical manifestation of pseudoSAH includes encephalopathy symptom such as unconsciousness,headache,seizure,etc.Cranial CT shows diffuse cerebral edema,high density of cerebral fissure and cerebral ventricle,and there is no bloody cerebrospinal fluid via lumbar puncture.Prognosis of pseudo-SAH is often bad.And most patients show critically illness and high mortality.