BACKGROUND:Transposition of the long head of biceps tendon is a commonly surgical method for massive rotator cuff tears.Currently,there are a few reports on the clinical efficacy of the transposition of the long head of biceps tendon and there is no consensus on the influencing factors for retearing. OBJECTIVE:To observe the outcome of arthroscopic long head of the biceps tendon in the treatment of massive rotator cuff tear. METHODS:The clinical data of 28 patients with massive rotator cuff tears,aged(61.79±10.50)years,admitted at Jiangsu Province Hospital of Chinese Medicine from March 2019 to May 2022 were retrospectively analyzed.All patients underwent arthroscopic long head of the biceps tendon.Patients were assessed for visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion before and 1 year after operation.MRI of the shoulder joint was performed for observing the integrity of the repaired structure at 1 year after operation.Twenty-three patients(5 of 28 lost to follow-up)were categorized into the intact tendon group(n=18)and the tendon retear group(n=5)according to the Sugaya typing at 1 year after operation;the patients were divided into the normal group(n=8),the degeneration group(n=9),and the partial tear group(n=6)according to the intraoperative quality of the long head of the biceps tendon.Differences in the above indexes were compared between groups. RESULTS AND CONCLUSION:When followed up at 1 year after surgery,the range of motion,visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores of the shoulder were significantly improved compared with preoperative data(P＜0.05).There was a significant difference in Goutellier grading between intact tendon and tendon retear groups(P＜0.05),while no significant difference was observed in the other influencing factors(P＞0.05).There were no significant differences in visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion at 1 year after operation among the normal,degeneration,and partial tear groups(P＞0.05).MRI findings indicated that the sutured tendon healed well in 18 patients,with a healing rate of 78%.Arthroscopic long head of the biceps tendon for augmented repair can provide a reliable repair for massive rotator cuff tear that is refractory,significantly alleviate the pain of the shoulder joint,and restore the function of the shoulder joint.

Objective:To investigate the risk factors and their warning effectiveness for meniscus tear secondary to delayed anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective cohort study was conducted to analyze the clinical data of 114 patients (114 knees) with ACL injury, who were admitted to Affiliated Hospital of Nanjing University of Chinese Medicine from December 2018 to December 2023, including 78 males and 36 females, aged 11-50 years [29(21, 35)years]. The patients were divided into tear group ( n=46) and non-tear group ( n=68) according to whether combined with meniscus tear or not during the surgery. Gender, age, duration of disease, smoking history, Body Mass Index (BMI), cause of injury, mechanism of injury, side of the injury, Beighton score, difference of KT-2000 examination, Tegner activity scale of the knee joint, anterior tibial translation sign, medial posterior tibial slope angle, lateral posterior tibial slope angle, and pivot shift grading of the patients in the two groups were recorded. Correlations between the above-mentioned indicators and occurrence of meniscus tear secondary to delayed ACL reconstruction were assessed. In the meantime, the independent risk factors were determined by univariate and multivariate binary logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the warning effectiveness of each risk factor for meniscal tear secondary to delayed ACL reconstruction. Results:Univariate analysis showed correlation of duration of disease, BMI, Tegner activity scale of the knee joint, medial posterior tibial slope angle, lateral posterior tibial slope angle and high-grade pivot shift with occurrence of meniscus tear secondary to delayed ACL reconstruction ( P<0.01). The results of multivariate binary logistic regression analysis showed that the duration of disease ≥14.5 weeks ( OR=1.20, 95% CI 1.05, 1.38, P<0.01), BMI≥26.9 kg/m 2 ( OR=1.36, 95% CI 1.03, 1.81, P<0.05), Tegner activity scale of the knee joint ≥4 points ( OR=2.29, 95% CI 1.18, 4.46, P<0.05), medial posterior tibial slope angle ≥11.2° ( OR=2.27, 95% CI 1.06, 4.89, P<0.05) and high-grade pivot shift ( OR=0.03, 95% CI 0.01, 0.03, P<0.05) were significantly correlated with occurrence of meniscus tear secondary to delayed ACL reconstruction. Results of ROC curve analysis showed that the medial posterior tibial slope angle (AUC=0.86, 95% CI 0.80, 0.93) and duration of disease (AUC=0.85, 95% CI 0.77, 0.92) had good warning value, BMI (AUC=0.78, 95% CI 0.69, 0.87) and Tegner activity scale of the knee joint (AUC=0.73, 95% CI 0.64, 0.83) had ordinary warning value, and the warning value of high-grade pivot shift (AUC=0.60, 95% CI 0.49, 0.71) was the lowest. The combination of the risk factors revealed superior warning effectiveness for meniscus tear second to delayed ACL reconstruction (AUC=0.97, 95% CI 0.96, 1.00). Conclusions:The duration of disease ≥14.5 weeks, BMI ≥26.9 kg/m 2, Tegner score ≥4 points, medial posterior tibial slope angle ≥11.2°and high-grade pivot shift are independent risk factors for meniscus tear secondary to delayed ACL reconstruction. The medial posterior tibial slope angle and duration of disease have good warning value, BMI and Tegner scores have ordinary warning value and high-grade pivot shift has the lowest warning value. The combination of the above risk factors has better warning effectiveness for meniscus tear secondary to delayed ACL reconstruction.

Objective:To study the feasibility and efficacy of pericranial flaps for the repairs of large anterior skull base defects.Methods:The average length of the pericranial flaps needed for skull base repair was determined with computed tomography measurements in 20 adults and anatomical dissections in 5 cadaver specimen. A series of patients who underwent endoscopic skull base surgeries and subsequent reconstructions with pericranial flaps at the Department of Otolaryngology Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital from 2016 to 2022 were retrospectively reviewed. There were 19 males and 6 females, aged from 11 to 59 years, including 13 cases of cerebrospinal fluid (CSF) rhinorrhea (12 traumatic) and 12 cases of sinonasal skull base tumors. Descriptive statistical methods were used.Results:The mean areas of anterior skull base, sellar, and clival defects were 16.13, 14.03 and 13.12 cm 2, respectively, and the mean pericranial flap lengths were (18.77±3.44)mm, (133.99±5.08)mm, (181.76±6.31)mm, respectively. Among sinonasal skull base neoplasms, the pathologies included olfactory neuroblastoma ( n=6), squamous cell carcinoma ( n=3), chondrosarcoma ( n=1), osteosarcoma ( n=1), and invasive schwannoma ( n=1), in whom 8 patients underwent adjuvant radiotherapy after surgery. One patient (7.7%) had acoustic neuroma-related CSF leak before radiotherapy. All 25 patients successfully underwent skull base reconstruction without complications such as CSF leak, intracranial infection, forehead wrinkles disappearance, or scalp necrosis. All flaps survived well with no CSF leaks within the follow-up period of 2-4 years. Conclusion:Pericranial flap is a safe choice for large anterior skull base defects following resection of sinonasal skull base neoplasms and complex traumatic CSF leaks when endonasal flaps are not available.

Humans ; Phosphorylation ; Serine/metabolism* ; Protein Serine-Threonine Kinases/metabolism* ; Signal Transduction ; Neovascularization, Pathologic

Objective:To explore the feasibility and safety of endovascular interventional embolization in pregnancy-related acute large vessel occlusive stroke.Methods:Three patients with pregnancy-related acute large-vessel occlusive stroke accepted endovascular interventional embolization in Department of Neurology, Jining First People's Hospital from November 2017 to June 2021 were chosen; their clinical data and treatment efficacy were retrospectively analyzed.Results:Two patients were in early pregnancy and one was in puerperium; they were with acute anterior circulation large vessel occlusion, including one with occlusion of the M1 segment of the right middle cerebral artery, one with occlusion of the ophthalmic segment of the left internal carotid artery, and one with occlusion of the traffic segment of the left internal carotid artery; cardiogenic embolism was considered, and the risk factors for embolism included unclosed foramen ovale ( n=1), rheumatic heart disease ( n=1), and atrial fibrillation ( n=1); embolization was performed by catheter aspiration in one patient and stenting in two patients; all vessels were well re-canalized with modified thrombolysis in cerebral infarction (mTICI) 3; two patients had a good prognosis 90 d after embolization (mRS scores of 0 and 2) and one had a poor prognosis (mRS scores of 4); no surgical complications occurred. Conclusion:Endovascular interventional embolization after individualized evaluation may be a safe and effective approach for patients with pregnancy-related acute large vessel occlusive stroke.

Homogeneous management of multi-campus medical care is an effective way to promote the expansion of high-quality medical resources, improve medical quality, and ensure medical safety. The Second Affiliated Hospital Zhejiang University School of Medicine actively explored an integrated and high-quality management mode to effectively improve medical service capacity, ensure medical technology and quality, and enhance hospital influence and social benefits from three dimensions: unified establishment, implementation of core elements, and unified quality and safety evaluation and monitoring. These practices had achieved good results and could provide reference for the multi-campus construction of other large public hospitals.

Objective:To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension.Methods:Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients.Results:Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [ OR and 95% CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [ OR and 95% CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. Conclusions:The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.

Objective To summarize the therapeutic effects of living related donor liver transplantation for Crigler-Najjar syndrome type Ⅰ (CNS type Ⅰ). Methods A 3-month-old male infant had appeared a progressive xanthochromia of the skin and sclera 4 d after birth without obvious cause. Other causative factors were eliminated after relevant tests were completed, and identified as CNS type Ⅰ by genetic testing. Living related donor liver transplantation was performed with his mother as the donor. An immunosuppression regimen was routinely applied postoperatively and tacrolimus doses were adjusted according to biochemical indicators and cytochrome P450 (CYP) 3A5 genotype of the recipient. Results The liver enzymes of the recipient returned to normal at 7 d postoperatively, and bilirubin decreased daily and fell to the normal range at 22 d postoperatively. Followed up to the submission date, the recipient's xanthochromia of skin and scleral faded with normal bilirubin and stable liver enzymes. The condition of the recipient was generally good with high quality of life. Conclusions Living donor liver transplantation can treat unconjugated hyperbilirubinemia and other diseases caused by CNS type Ⅰ, which greatly improve the quality of life of patients.

Objective: To investigate the immunohistochemical staining of anaplastic lymphoma kinase (ALK; clone 1A4) in pediatric medulloblastoma (MB). Methods: Molecular subtyping was performed based on the NanoString and sequencing techniques for 44 pediatric MB cases at Children′s Hospital, Zhejiang University School of Medicine from 2014 to 2017. ALK expression was detected with EnVision immunhistochemistry using ALK clone 1A4 on whole section. Statistical analyses were performed to evaluate the correlation of protein expression with molecular subgroups. Results: The age ranged from 0.5 to 13.0 years with an average age of 5.8 years. There were 28 males and 16 females, and 31 classic, 5 desmoplastic nodular, 3 extensive nodular and 5 large cell/anaplastic MBs. Except three cases was unable classified, 41 MBs were classified into the four molecular groups: 5 in WNT group, 12 in SHH group, 9 in Group 3 and 15 in Group 4. Thirteen of 44 MB cases were positive staining for ALK, and the positive rate was 29.5%. Six cases were strong reaction, and 7 cases were weak. The expression of ALK at the protein level was associated with the WNT group (P<0.01). The characteristic perinuclear dot-like staining was only showed in WNT group. Conclusions The ALK immunhistochemistry using antibody clone 1A4 is a useful marker for the molecular subgroup detection of MB. The strong staining and perinuclear dot-like staining indicate as WNT group.

Objective To evaluate the diagnostic efficacy of magnetic resonance(MR)-guided prostate biopsy based on abnormal diffusion weighted imaging for prostate cancer in elder men.Methods From July 2014 to Dec 2016,56 patients (age≥ 65 years) with diffusion weighted imaging (DWI)abnormalities undergoing MR-guided prostate biopsy were retrospectively evaluated.According to pathological diagnosis,patients were divided into prostate cancer and non-prostate cancer groups.The clinical data of two groups were analyzed.The correlation of Gleason score,prostate specific antigen(PSA),and the location and number of biopsy were compared.Results Among 56 cases,32 (57.1％)were diagnosed as prostate cancer,and 24 (42.9％)as chronic prostatitis and prostatic hyperplasia (non-prostate cancer).There were statistically significant differences between prostate cancer and non-prostate cancer in age[(73.0±5.7)vs.(70.1±4.3)year]and PSA[(9.3±6.0)μg/L vs.(6.0± 3.9)μg/L] (both P＜0.05),and no statistical differences in biopsy location and biopsy number(t =2.08,2.37,P＞ 0.05).Gleason score had no correlation with PSA level and biopsy location and biopsy number(r=0.189、-0.183、0.082,P＞0.05).Conclusions MR-guided prostate biopsy based on MR-DWI has some merits,such as accurate positioning,fewer numbers of biopsy,and lower false-negative rate.