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

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.

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 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.

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.

Objective To use nerve conduction study (NCS) to evaluate the function of large fibers,skin sympathetic response (SSR) and contact heat evoked potential (CHEP) to evaluate the function of small fibers in patients with impaired glucose regulation (IGR),and to analyze the occurrence of peripheral neuropathy and damage characteristics.Methods According to the classification criteria of glucose metabolism proposed by WHO in 2006,we selected 120 patients with IGR from January 2015 to December 2016 in our hospital,including 37 impaired fasting glucose (IFG) patients,83 impaired glucose tolerance (IGT) patients,and 60 normal subjects served as control group.All subjects received median,ulnar,tibial,peroneal,sural NCS,SSR and CHEP using the Keypoint.net (Medoc Ltd) electromyogram device.IGR patients were evaluated using the Michigan Neuropathy Screening Instrument (MNSI).Results The abnormal rate of MNSI score in IGR patients was 18.3％ (22/120);the abnormal rate of NCS was 22.5％ (27/120),and the abnormal rate of SSR was 39.2％ (47/120).In IFG group,the abovementioned abnormal rates were 8.1％ (3/37),13.5％ (5/37),29.7％ (11/37) respectively,and 22.9％ (19/83),26.5％ (22/83),43.4％ (36/83) in IGT group.Compared with control group,the tibial,sural nerve sensory nerve action potential amplitude decreased in IGT group (1.3 (0.1,1.9) μV vs 1.4(1.1,3.2) μV,Z=-3.05,P=0.002;(10.5±2.0)μV vs (7.6 ± 1.9)μV,t=0.60,P=0.001);and there was no significant difference between IFG patients and control group.Compared with control group,IFG patients' SSR amplitude reduced in lower limbs (0.7 (0.4,0.8) mV vs 0.8 (0.6,1.0) mV,Z =-2.95,P =0.003),CHEP amplitude decreased in dorsum hand and peroneal area stimuli ((63.0 ±10.0)μV vs(52.4 ±15.3)μV,t=0.61,P=0.003;(44.7 ±12.5)μV vs (28.2 ± 10.6)μV,t=0.31,P =0.000);and in IGR group,SSR amplitude reduced in upper and lower limbs (1.1 (0.5,2.2) mV vs 1.3(0.7,2.6)mV,Z=-2.12,P=0.030;0.4(0.2,0.8)mV vs 0.8(0.6,1.0) mV,Z=-5.96,P=0.000),CHEP amplitude decreased in dorsum hand and peroneal area stimuli ((63.0 ± 10.0) μV vs (38.7± 13.5)μV,t =0.37,P=0.000;(44.7 ±12.5)μV vs(21.9 ± 13.6)μV,t =0.35,P=0.000).Conclusions There is peripheral neuropathy in IGR patients,and the incidence of neuropathy in patients with IGT is higher than those with IFG.Neurophysiological methods are earlier than clinical scores to detect neuropathy.There are only small fiber damages in IFG patients,and IGT patients present by large and small fibrous lesions,mainly in small fibers and lower sensory nerve fibers,characterized by axonal damage and length dependence.

Objectives To study the early effect of treating teenagers with tibial insertion avulsion fracture of anterior cruciate ligament using the single-tibal tunnel,double Endobutton miniature steel plate combined with twin high-strength Ultrabraid Suture suspension fixation under an anthroscopy.Methods Retrospective analysis was conducted on 21 teenagers with tibial insertion avulsion fracture of anterior cruciate ligament treated between May 2012 and June 2015.They were treated using the single-tibal tunnel,double Endonbutton plate combined with twin Ultrabraid Suture suspension system fixation.The X-ray was taken postoperatively at 1 week,1 month,3 months and every 6 months.Anterior drawer and Lachman tests were used to evaluate the postoperative stability of knee joints,while the Lysholm score was recorded to assess the postoperative recovery.Results The average total intraoperative blood loss,operation duration and follow-up time were(53.95 ± 7.10) ml (ranging from 43 to 68 ml),(38.76 ± 7.71)min(ranging between 27 and 55 min),and(21.86 ± 2.78)months,ranging from 18 to 25 months.All fractures were healed without malunion or nonunion as could be seen in the X-ray taken 3 months after the operation.Moreover,none of the patients suffered from complications such as soft tissue infections or extension lag of the knee joints caused by the femoral intercondylar notch impingement syndrome.The Lysholm score of the last follow-up(97.14 ± 1.35)was significantly higher than that before surgery (40.24 ± 5.81).Conclusion The early efficacy of the single-tibal tunnel,double Endonbutton plate combined with twin Ultrabraid Suture suspension system fixation for teenagers with tibial insertion avulsion fracture of anterior cruciate ligament under arthroscopy is satisfactory.