Objective:To analyze and compare the clinical efficacy of minimally invasive modified Bristow-Latarjet and Bankart prosthesis in the treatment of recurrent shoulder dislocation.Methods:A total of 58 patients with recurrent shoulder dislocation treated in the Hubei Minzu University Affiliated Minda Hospital from October 2019 to December 2022 were retrospectively selected, and 29 patients underwent minimally invasive modified Bristow-Latarjet (Latarjet group) and 29 patients underwent Bankart prosthesis (Bankart group). The basic conditions of surgery, postoperative shoulder joint activity, and postoperative Rowe Shoulder Function Score (Rowe score) of the two groups were compared. The shoulder function recovery of the patients was evaluated using the American Shoulder and Elbow Association Scoring (ASES) system and the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the incidence of complications between the two groups were compared.Results:The operation time, incision length, intraoperative bleeding volume, recovery working time, and reset loss in the Latarjet group were shorter than those in the Bankart group: (45.56 ± 12.18) min vs. (70.35 ± 18.14) min, (4.04 ± 0.82) cm vs. (6.75 ± 0.95) cm, (61.54 ± 8.88) ml vs. (86.07 ± 7.53) ml, (13.31 ± 3.21) weeks vs.(16.24 ± 3.33) weeks, (0.97 ± 0.19) mm vs.(1.24 ± 0.35)mm, there were statistical differences ( P<0.01). The outreach and forward angles in the Latarjet group were higher than those in the Bankart group: (138.25 ± 10.36)° vs. (98.15 ± 9.64)°, (140.14 ± 10.43)° vs. (93.79 ± 8.84)°, there were statistical differences ( P<0.01). The total effective rate in the Latarjet group was higher than that in the Bankart group: 96.55%(28/29) vs. 75.86%(22/29), there was a statistical difference ( χ2 = 5.22, P = 0.022). The Rowe scores after operation in the Latarjet group were higher than that in the Bankart group: (82.52 ± 15.89) scores vs. (66.78 ± 15.34) scores, there was a statistical difference ( P<0.01). The scores of self-assessment and physician assessment of ASES system and UCLA shoulder scores after operation in the Latarjet group were higher than those in the Bankart group: (36.13 ± 8.45) scores vs. (30.17 ± 8.48) scores, (40.03 ± 9.54) scores vs. (34.25 ± 8.74) scores, (32.08 ± 2.44) scores vs. (27.49 ± 2.56) scores, there were statistical differences ( P<0.05). The complication rate in the Latarjet group was lower than that in the Bankart group: 6.90%(2/29) vs. 31.03%(9/29), there was a statistical difference ( χ2 = 5.50, P = 0.019). Conclusions:The minimally invasive modified Bristow-Latarjet in the treatment of recurrent dislocation of the shoulder joint is superior to Bankart prosthesis in terms of shoulder functional recovery and postoperative rehabilitation.

Objective:To analyze and compare the clinical efficacy of minimally invasive modified Bristow-Latarjet and Bankart prosthesis in the treatment of recurrent shoulder dislocation.Methods:A total of 58 patients with recurrent shoulder dislocation treated in the Hubei Minzu University Affiliated Minda Hospital from October 2019 to December 2022 were retrospectively selected, and 29 patients underwent minimally invasive modified Bristow-Latarjet (Latarjet group) and 29 patients underwent Bankart prosthesis (Bankart group). The basic conditions of surgery, postoperative shoulder joint activity, and postoperative Rowe Shoulder Function Score (Rowe score) of the two groups were compared. The shoulder function recovery of the patients was evaluated using the American Shoulder and Elbow Association Scoring (ASES) system and the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the incidence of complications between the two groups were compared.Results:The operation time, incision length, intraoperative bleeding volume, recovery working time, and reset loss in the Latarjet group were shorter than those in the Bankart group: (45.56 ± 12.18) min vs. (70.35 ± 18.14) min, (4.04 ± 0.82) cm vs. (6.75 ± 0.95) cm, (61.54 ± 8.88) ml vs. (86.07 ± 7.53) ml, (13.31 ± 3.21) weeks vs.(16.24 ± 3.33) weeks, (0.97 ± 0.19) mm vs.(1.24 ± 0.35)mm, there were statistical differences ( P<0.01). The outreach and forward angles in the Latarjet group were higher than those in the Bankart group: (138.25 ± 10.36)° vs. (98.15 ± 9.64)°, (140.14 ± 10.43)° vs. (93.79 ± 8.84)°, there were statistical differences ( P<0.01). The total effective rate in the Latarjet group was higher than that in the Bankart group: 96.55%(28/29) vs. 75.86%(22/29), there was a statistical difference ( χ2 = 5.22, P = 0.022). The Rowe scores after operation in the Latarjet group were higher than that in the Bankart group: (82.52 ± 15.89) scores vs. (66.78 ± 15.34) scores, there was a statistical difference ( P<0.01). The scores of self-assessment and physician assessment of ASES system and UCLA shoulder scores after operation in the Latarjet group were higher than those in the Bankart group: (36.13 ± 8.45) scores vs. (30.17 ± 8.48) scores, (40.03 ± 9.54) scores vs. (34.25 ± 8.74) scores, (32.08 ± 2.44) scores vs. (27.49 ± 2.56) scores, there were statistical differences ( P<0.05). The complication rate in the Latarjet group was lower than that in the Bankart group: 6.90%(2/29) vs. 31.03%(9/29), there was a statistical difference ( χ2 = 5.50, P = 0.019). Conclusions:The minimally invasive modified Bristow-Latarjet in the treatment of recurrent dislocation of the shoulder joint is superior to Bankart prosthesis in terms of shoulder functional recovery and postoperative rehabilitation.

Objective:To observe the surgical methods and clinical efficacy on reconstruction of digital flexion function using transfer of modified free gracilis myocutaneous flap.Methods:Between March 2014 and August 2022, 7 male patients, aged between 23 and 38 (average age 28) years old, were treated by reconstruction of forearm flexor function using modified free gracilis myocutaneous flap transfer to overcome the dysfunction in the Department of Hand and Foot Surgery, Zhejiang Rongjun Hospital. After the scar excision, the defects in forearm ranged from 15.0 cm × 4.5 cm to 28.0 cm × 6.5 cm, with flap excision areas of 17.0 cm × 5.5 cm to 30.0 cm × 8.0 cm. The nerve carried by the myocutaneous flap was anastomosed with the musculi branch of the median nerve, and the perforator artery and vein of the gracilis muscle were anastomosed with the brachial artery or the branch of ulnar artery and radial artery. Six patients had the flap donor sites directly closed primarily. A medium-thickness skin graft was taken from the ipsilateral groin area in 1 patient, to cover the remaining wound after the primary closure for wound reduction. Postoperative clinical efficacy was monitored through the follow-ups via visits of outpatient clinic, telephone calls or WeChat interviews.Results:After surgery, 1 patient experienced a vascular compromise of the flap, which was resolved after reanastomosis. One patient had a necrotic in distal flap about 2.0 cm×1.0 cm in size, which healed after dressing change. All other 5 flaps survived successfully. The postoperative follow-up ranged from 12 to 36 months, at 18 months in average. The flaps had good appearance and texture. Protective sensation recovered to varying degrees at 6 months after surgery. At 2 years after surgery, all of 7 patients showed significant improvement in hand and forearm appearance, along with restored finger flexion, grasping and partial hand function. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, flexion function recovered to excellent in 1 patient, good in 3 patients and fair in 3 patients. In the donor sites, there were only linear scars or mild pigmentation without significant loss of function.Conclusion:A modified free gracilis myocutaneous flap transfer is used to reconstruct digit flexion function. The procedure is safe and reliable, with a quick and relatively postoperative and satisfactory recovery in forearm flexion function, hence makes it an ideal surgical technique for reconstruction of digit flexion function.

Objective To investigate the dietary patterns of rural residents in the high-incidence areas of esophageal cancer (EC), and to explore the clustering and influencing factors of risk factors associated with high-incidence characteristics. Methods A special structured questionnaire was applied to conduct a face-to-face survey on the dietary patterns of rural residents in Yanting county of Sichuan Province from July to August 2021. Univariate and multivariate logistic regression models were used to analyze the influencing factors of risk factor clustering for EC. Results There were 838 valid questionnaires in this study. A total of 90.8% of rural residents used clean water such as tap water. In the past one year, the people who ate fruits and vegetables, soybean products, onions and garlic in high frequency accounted for 69.5%, 32.8% and 74.5%, respectively; the people who ate kimchi, pickled vegetables, sauerkraut, barbecue, hot food and mildew food in low frequency accounted for 59.2%, 79.6%, 68.2%, 90.3%, 80.9% and 90.3%, respectively. The clustering of risk factors for EC was found in 73.3% of residents, and the aggregation of two risk factors was the most common mode (28.2%), among which tumor history and preserved food was the main clustering pattern (4.6%). The logistic regression model revealed that the gender, age, marital status and occupation were independent influencing factors for the risk factors clustering of EC (P<0.05). Conclusion A majority of rural residents in high-incidence areas of EC in Yanting county have good eating habits, but the clustering of some risk factors is still at a high level. Gender, age, marital status, and occupation are influencing factors of the risk factors clustering of EC.

Objective: To establish a method for determining the content of bear bile powder in Longze Xiongdan capsules with taursodeoxycholic acid（TUDCA） and taurchenodeoxycholic acid（TCDCA） as indexes.
Methods: HPLC series evaporation photodetector was adopted on Chrom Core AQ C₁₈ column(4.6 mm×250 mm, 5 μm), with the mobile phase comprising of acetonitrile ( A ) and 5 mmol·L^-1 ammonium acetate solution (B) in a gradient elution (0-40 min, 25%A; 40-50 min, 25%A→29%A; 50-80 min, 29%A; 80-100 min, 29%A→40%A) at the flow rate of 1.0 mL·min^-1. The column temperature was 30 ℃. The ELSD was used, of which the drift tube temperature was 110 ℃ and the flow rate of carrier gas（N₂） was 2.5 L·min^-1.
Results: In the ranges of 1.069-9.57 μg and 0.740 46-7.404 64 μg, logarithms of the injected amount of TUDCA and TCDCA presented good linear relationships with logarithms of the peak area, respectively. The RSDs of precision, repeatability and stability tests were all lower than 2.0%. At three concentration levels the recoveries of TUDCA and TCDCA were 95.2%-97.7% and 91.9%-95.9%, respectively. Samples of 42 batches showed that the contents of TUDCA and TCDCA were 0.18-0.43 and 0.10-0.44 mg·granule^-1, respectively.
Conclusion: This method can be used for the quality control of bear bile powder in Longze Xiongdan capsules, thus provides a scientific basis for improving its quality standard.

Objective To investigate the age-related changes of biomechanical properties for humerus, femur and tibia in male rats and their application values in age estimation. Methods According to different weeks of age, 90 healthy male SD rats were divided into 2, 4, 6, 8, 17, 26, 52, 78 and 104-week groups with 10 rats in eachgroup. After the rats were executed by excessive anesthesia, humerus, femur, and tibia were separated and the attached soft tissues were removed. The length of the above-mentioned bones and the diameter of the middle section (compression site) were measured with vernier caliper, and the three-point bending test was conducted with electronic universal material testing machine to detect the ultimate load and displacement under ultimate load. Results There were significant differences in the ultimate load of humerus, femur and tibia among male rats in different age groups (P<0. 05). With the increase of week age, the ultimate loads of the humerus, femur and tibia increased first and then decreased, and reached the peak value in 52-week age group, showing a strong positive correlation with week age before 52 weeks ( r = 0. 884,0. 933,0. 929, P<0. 05). There was no significant difference in humerus and tibia. The displacement of femur under ultimate load was weakly positively correlated with week age (R= 0. 406,P<0. 05). The age prediction accuracy for automatic linear modeling of ultimate load for humerus, femur, tibia and three above-mentioned bones in rats before 52-week age was 78. 2% , 86. 8% , 84. 1% and 88. 3% , respectively. There was a strong positive correlation between the length of humerus, femur and tibia and the ultimate load (R= 0. 904, 0. 897, 0. 814, P<0. 05). The diameters of humerus, femur and tibia were strongly positively correlated with the ultimate load (R = 0. 759, 0. 814 and 0. 745, P<0. 05). Conclusions The ultimate loads of humerus, femur and tibia in male rats increased first and then decreased with age, and were positively correlated with age before 52 weeks, which could be used for age inference. The highest accuracy of age estimation was ultimate loads of three bones, followed by femur. The length/ middle diameter of humerus, femur and tibia were strongly positively correlated with the ultimate load.

Objective To investigate the effect of different optimization algorithms on accurate reconstruction of traffic accidents. Methods Non-dominated sorting genetic algorithm-II ( NSGA-II), neighborhood cultivation genetic algorithm (NCGA) and multi-objective particle swarm optimization (MOPSO) were used to optimize the multi-rigid body dynamic reconstruction of a real case. The effects of different optimization algorithms on convergence speed and optimal approximate solution were studied. The optimal initial impact parameters were simulated as boundary conditions of finite element method, and the simulated results were compared with the actual injuries. Results NCGA had a faster convergence speed and a better result in optimization process. The kinematic response of pedestrian vehicle collision reconstructed by the optimal approximate solution was consistent with the surveillance video. The prediction of craniocerebral injury was basically consistent with the cadaver examination. Conclusions The combination of optimization algorithm, rigid multibody and finite element method can complete the accurate reconstruction of traffic accidents and reduce the influence of human factors.

Objective To analyze the influencing factors of post-operative delirium (POD) in middle-aged and elderly patients in intensive care unit (ICU) and construct risk prediction model for it.Methods A total of 112 middle-aged and elderly postoperative patients in the ICU of Lu'an Hospital of Anhui Medical University from January, 2018 to February, 2021 were selected. On the second day after the operation, they were transferred to ICU, and assessed with the Confusion AssessmentMethod for Intensive Care Unit (CAM-ICU). The patients were divided into delirium group (n = 52) and non-delirium group (n = 60) according to assessment. Univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent influencing factors to construct risk prediction model. Receiver operating characteristic (ROC) curve was used to evaluate prediction performance. Results Multivariate logistic regression analysis showed Acute Physiology and Chronic Health Evaluation II score (APACHE II score) (OR = 1.424, 95%CI 1.204 to 1.685, P < 0.001), ICU sleep quality score (OR = 1.432, 95%CI 1.159 to 1.770, P < 0.001), and postoperative oxygenation index ≤ 300 (OR = 4.485, 95%CI 1.644 to 12.240, P = 0.001) were independent influencing factors of postoperative delirium in ICU. The prediction model was: logit(P) = -11.381+0.354X1 (APACHE II score, cut-off value 16)+0.359X2 (ICU sleep quality score, cut-off value 13)+1.501X3 (postoperative oxygenation index ≤ 300), with the sensitivity and specificity of 79.2% and 79.7% respectively. The area under the ROC curve was 0.866 (95%CI 0.801 to 0.930), more than those of the factors alone (P < 0.05). Conclusion The prediction model based on Logistic regression can predict the occurrence of postoperative delirium in middle-aged and elderly patients in ICU.

Luohu District of Shenzhen has implemented the global budget management mode as " surplus reward, no compensation for overspending and reasonable sharing" in the hospital group, which continued to strengthen cooperation, optimize services, reduce costs, and improve health outcomes. The authors employed the game theory to build a game model of medical alliance under Luohu global budget management mode, discussing the reasons of medical and health institution′s stronger cooperation and what could be improved in Luohu′s case. Based on the experience of Luohu total budget management, it is suggested that when implementing total budget, all localities should improve closed-loop management, expand coverage, adopt compound medical insurance payment method, promote outpatient coordination, strengthen assessment and incentives, so as to give full play to the incentive role of total budget.

Germany has introduced the " point method" of fee-for-service at the outpatient departments under a global budget system, in an effort to curb medical expenditure growth. The authors employed the game theory to build a physician′s game model under Germany′s point method, illustrating the causes of " increasing points" behaviors of physicians, the negative effects caused by the increase of points as well as the prevention and control measures employed by Germany and its mechanism. Point method payment has been introduced in several areas in China at their inpatient departments, which is delivered to medical service providers via the performance-based distribution model, with the providers affected in their behaviors. As a result, some areas will tend to appear such " increasing points" behaviors as competing for patients, lowering admission criteria, and raising point value. In view of Germany′s experiences, China should adopt such measures as dynamic monitoring system, disclosure of " increasing points " behaviors, perfection of hierarchical medical system, and strengthening the self-governance via medical sector′s associations.