Objective:To explore the effects of anterior cruciate ligament (ACL) reconstruction combined with lateral extra-articular tenodesis (LET) on the postoperative knee stability in the patients with ACL injury combined with high grade pivot-shift phenomenon.Methods:A retrospective study was conducted to analyze the 62 patients with primary ACL injury and high-grade pivot-shift phenomena who had been treated and followed up for at least 1 year at Sports Medicine Center, The First Affiliated Hospital, Army Medical University between January 2021 and December 2022. There were 37 males and 25 females, with an age of (29.3±7.0) years. By the different treatment methods, the patients were divided into a trial group of 25 cases treated by ACL reconstruction plus LET and a control group of 37 cases treated by ACL reconstruction only. The International Knee Documentation Committee (IKDC) subjective score, knee Lysolm score, anterior-posterior stability of the knee (KT-1000 side-to-side disparity), rotational stability (axial shift test), and anterior subluxation of the lateral compartment (ASLC) were compared between preoperation and 1 year postoperation, as well as between the 2 groups.Results:There were no significant differences between the 2 groups in the preoperative general data, indicating comparability ( P>0.05). Surgical procedures went on uneventfully in all patients. At 1 year postoperatively in the trial group, the IKDC subjective score [(86.0±7.2) points] and Lysholm score [(87.1±6.0) points] were significantly higher than those in the control group [(81.8±6.8) points and (82.1±5.5) points], and the side-to-side disparity [0.7 (0.0, 2.0) mm] was significantly smaller than that in the control group [2.3 (0.0, 4.0) mm], the percentage of postoperative residual pivot-shift positivity [8.0% (2/25)] was significantly lower than that in the control group [32.4% (12/37)], and the ASLC [(4.5±2.6) mm] was significantly smaller than that in the control group [(6.2±2.6) mm] (all P<0.05). At 1 year postoperatively in both groups, the of IKDC subjective score,Lysolm score, side-to-side disparity, axial shift test, and ASLC were significantly better than the preoperative values ( P<0.05). Conclusion:In the treatment of the patients with ACL injury plus high grade pivot-shift phenomenon, compared with ACL reconstruction alone, ACL reconstruction plus LET enhances their postoperative knee stability and functional outcomes, reduces their residual rotational laxity, and improves their ASLC.

Objective:To explore the effects of anterior cruciate ligament (ACL) reconstruction combined with lateral extra-articular tenodesis (LET) on the postoperative knee stability in the patients with ACL injury combined with high grade pivot-shift phenomenon.Methods:A retrospective study was conducted to analyze the 62 patients with primary ACL injury and high-grade pivot-shift phenomena who had been treated and followed up for at least 1 year at Sports Medicine Center, The First Affiliated Hospital, Army Medical University between January 2021 and December 2022. There were 37 males and 25 females, with an age of (29.3±7.0) years. By the different treatment methods, the patients were divided into a trial group of 25 cases treated by ACL reconstruction plus LET and a control group of 37 cases treated by ACL reconstruction only. The International Knee Documentation Committee (IKDC) subjective score, knee Lysolm score, anterior-posterior stability of the knee (KT-1000 side-to-side disparity), rotational stability (axial shift test), and anterior subluxation of the lateral compartment (ASLC) were compared between preoperation and 1 year postoperation, as well as between the 2 groups.Results:There were no significant differences between the 2 groups in the preoperative general data, indicating comparability ( P>0.05). Surgical procedures went on uneventfully in all patients. At 1 year postoperatively in the trial group, the IKDC subjective score [(86.0±7.2) points] and Lysholm score [(87.1±6.0) points] were significantly higher than those in the control group [(81.8±6.8) points and (82.1±5.5) points], and the side-to-side disparity [0.7 (0.0, 2.0) mm] was significantly smaller than that in the control group [2.3 (0.0, 4.0) mm], the percentage of postoperative residual pivot-shift positivity [8.0% (2/25)] was significantly lower than that in the control group [32.4% (12/37)], and the ASLC [(4.5±2.6) mm] was significantly smaller than that in the control group [(6.2±2.6) mm] (all P<0.05). At 1 year postoperatively in both groups, the of IKDC subjective score,Lysolm score, side-to-side disparity, axial shift test, and ASLC were significantly better than the preoperative values ( P<0.05). Conclusion:In the treatment of the patients with ACL injury plus high grade pivot-shift phenomenon, compared with ACL reconstruction alone, ACL reconstruction plus LET enhances their postoperative knee stability and functional outcomes, reduces their residual rotational laxity, and improves their ASLC.

Objective:To investigate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) combined with bedside echocardiography in diagnosis and treatment of neonatal sepsis with cardiac dysfunction.Methods:A total of 56 children diagnosed with neonatal sepsis in the Neonatal Intensive Care Unit, Liaocheng People′s Hospital from July 2016 to July 2017 were enrolled and divided into 2 groups, namely, the cardiac dysfunction group (26 cases) and the non-cardiac dysfunction group (30 cases). Children with general infection (45 cases) hospita-lized at the same period were taken as the control group.The clinical characteristics, related laboratory indexes and prognosis were compared among 3 groups.The related factors of neonatal sepsis with cardiac dysfunction were analyzed by the multivariate Logistic regression approach, and the value of related indexes in the early prediction neonatal sepsis with cardiac dysfunction was analyzed by using the receiver operating characteristic curve (ROC). Results:The onset age of sepsis patients with cardiac dysfunction [63.0 h (30.5 h, 185.6 h)] was significantly earlier than that of the patients without cardiac dysfunction [65.0 h (34.5 h, 170.6 h)] and the control group [80.0 h (45.5 h, 202.3 h)] ( P<0.05). The main primary site of the disease was the lung, which was not statistically significant among the 3 groups ( P>0.05). The NT-proBNP level and the high sensitivity-C-reactive protein (hs-CRP)/albumin (ALB) ratio in the cardiac dysfunction group [20 230.6 ng/L (15 890.0 ng/L, 35 000.0 ng/L); 0.33(0.29, 0.81)] were significantly higher than those in the control group [7 324.5 ng/L (2 426.5ng/L, 13 890.0 ng/L); 0.06(0, 0.21)] (all P<0.05). The right ventricular diameter and the Tei index of the cardiac dysfunction group [(8.74±2.42) mm; 0.52±0.03] were significantly higher than those in the control group [(8.55±1.41)mm; 0.30±0.04], while the EF of the cardiac dysfunction group [(62.61±2.56)%] was significantly lower than that in the control group [(70.03±0.35)%] (all P<0.05). The ROC curve analysis showed that NT-proBNP and the Tei index could effectively predict sepsis with cardiac dysfunction.Specifically, NT-proBNP had a cutoff value of 12 291.5 ng/L, with sensitivity of 80%, specificity of 79%, and the area under ROC curve (AUC) of 0.81.The Tei index had a cutoff value of 0.45, with sensitivity of 74%, specificity of 77%, and the AUC of 0.78. Conclusions:NT-proBNP can be used as a marker of early cardiac dysfunction.Its combination with the Tei index of bedside echocardiography can quickly diagnose cardiac dysfunction of children with sepsis, better guide clinicians in drug use, improve cardiac function of patients and enhance the treatment effect.

Objective:To investigate the significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the early assessment of neonatal cardiac dysfunction in sepsis.Methods:The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit (NICU) of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled. Data of clinical sign, laboratory results, bedside echocardiography and survival data were collected, and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection. The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression, and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic (ROC) curve.Results:There were 112 neonates with sepsis (49 with cardiac dysfunction and 63 without cardiac dysfunction) and 67 children with common infection included in the analysis. The onset time of neonates in septic cardiac dysfunction group was significantly earlier than that of septic non-cardiac dysfunction group and common infection group [hours: 52.9 (0, 180.3) vs. 53.9 (0, 183.6), 81.0 (45.6, 202.4), both P < 0.05]. Compared with the general infection group, albumin (ALB), white blood cell count (WBC), left ventricular ejection fraction (LVEF) in septic cardiac dysfunction group significantly decreased, NT-proBNP, hypersensitive C-reactive protein (hs-CRP)/ALB, pulmonary artery systolic pressure (PASP) significantly increased, while right ventricular (RV) and Tei index significantly increased [ALB (g/L): 24.1±3.8 vs. 27.8±3.6, WBC (×10 9/L): 12.7 (3.7, 18.9) vs. 15.4 (9.9, 23.2), LVEF: 0.626±0.123 vs. 0.700±0.021, NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 7 324.5 (2 426.5, 13 890.0), hs-CRP/ALB: 0.33 (0.29, 0.81) vs. 0.06 (0.00, 0.21), PASP (mmHg, 1 mmHg = 0.133 kPa): 52.25±14.12 vs. 41.07±27.73, RV (mm): 10.74±2.42 vs. 8.55±1.41, Tei index: 0.52±0.03 vs. 0.30±0.04, all P < 0.05]. NT-proBNP and Tei index in septic cardiac dysfunction group were significantly higher than those in septic non-cardiac dysfunction group [NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 13 057.6 (8 946.0, 35 000.0), Tei index: 0.52±0.03 vs. 0.39±0.02, both P < 0.05], and LVEF was significantly lower than that in septic non-cardiac dysfunction group (0.626±0.123 vs. 0.671±0.086, P < 0.05). Multivariate Logistic regression analysis showed that NT-proBNP, Tei index and hs-CRP/ALB were independent risk factors for cardiac dysfunction in sepsis neonates [odds ratio ( OR) and 95% confidence interval (95% CI) were 8.73 (1.54-5.67), 1.97 (1.26-2.87), 1.87 (1.03-3.40) respectively, all P < 0.05]. ROC curve analysis showed that NT-proBNP, Tei index and hs-CRP/ALB had good predictive value for the occurrence of cardiac dysfunction in septic neonates, the area under ROC curve (AUC) was 0.81 (95% CI was 0.84-0.91), 0.78 (95% CI was 0.65-0.79) and 0.77 (95% CI was 0.61-0.77), respectively. The sensitivity and specificity of NT-proBNP were 80.0% and 79.0% respectively with 12 291.5 ng/L as the cut-off value, the sensitivity and specificity of Tei index were 74.0% and 77.0% respectively with 0.45 as the cut-off value, and the sensitivity and specificity of hs-CRP/ALB were 76.0% and 76.3% respectively with 0.10 as the cut-off value. Conclusions:NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction, and for rapid diagnosis of neonatal cardiac dysfunction in sepsis. The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.

BACKGROUND: With the increasing cases of posterior cruciate ligament injury, there are endless protocols for diagnosing and treating posterior cruciate ligament injury. However, there are few reviews of the integrity of posterior cruciate ligament. OBJECTIVE: To complete a comprehensive review of posterior cruciate ligament injury in terms of anatomy, clinical manifestations, auxiliary examination, treatment methods and rehabilitation strategies. METHODS: The PubMed, Ovid, CKNI, and WanFang databases were retrieved using the key words of “posterior cruciate ligament, PCL, anatom*, diagnos*, treatments, surger*, rehabilitation.” A total of 223 articles were searched. After removal of repetitive and ineligible literature, 65 articles were included for review. RESULTS AND CONCLUSION: Missed diagnosis and misdiagnosis of posterior cruciate ligament injury certainly exist. Posterior cruciate ligament injuries are mostly caused by traffic injuries and sports injuries, and are accompanied by other structural injuries to a certain degree. A full understanding of patient’s medical history, accurate physical examination methods, and sophisticated auxiliary examinations can help to correctly identify injuries to the posterior cruciate ligament and the surrounding structures, so as to formulate a reasonable diagnosis and treatment protocol. Research suggests that patients with posterior cruciate ligament injury should be subjected to reconstruction of the posterior cruciate ligament as soon as possible to reduce the risk of further degeneration. At present, there are still large disagreements on the diagnosis, treatment methods, and rehabilitation strategies of posterior cruciate ligament injury. So, a large number of rigorous randomized controlled trials are urgently needed to select the most suitable diagnosis and treatment methods.

Objective To study the clinical features,diagnosis,treatment and prognosis of neonatal fulminant myocarditis.Method From January 2016 to August 2016,clinical data of neonates with fulminant myocarditis admitted to the neonatal intense care unit (NICU) were retrospectively collected and analyzed.Result A total of 11 neonates were enrolled,including 6 males and 5 females,and 5 preterms and 6 full term infants.The average gestation age was (37.7 ± 1.6) weeks and their weight on hospital admission was (3 382 ± 675) g.Among the infants,9 got ill in summer and 2 in spring and winter.The onset of illness was within 3 ～ 5 d after birth in 8 cases and 2 ～ 3 weeks in the other 3 cases.The main clinical presentations included fever,anorexia,shortness of breath and lethargy.Various degrees of cardiac dysfunction appeared in all 11 cases,including cardiogenic shock in 10 cases,severe arrhythmias with multiple organ dysfunction in 7 cases,and viral meningitis in 7 cases.10 infants had significantly elevated brain natriuretic peptide (BNP) and troponin Ⅰ,and those with troponin Ⅰ above 20 μg/L had poor prognosis.A comprehensive treatment of limiting liquid volume,high-dose adrenocortical steroids,and IVIG were carried out.Meanwhile,therapy to prevent shock,improve cardiac function,reverse arrhythmia,and mechanical ventilation were used in children with dyspnea.7 cases were cured and 6 patients were followedup for 6 to 12 months.Among the 6 followed-up patients,within 1 ～3 months after discharge,4 cases had normal echocardiogram,and persistently abnormal echocardiogram were found in the other 2 cases and eventually confirmed as dilated cardiomyopathy.4 patients were dead.Conclusion The clinical manifestations of neonatal fulminant myocarditis are unspecific.It's difficult to recognize the early symptoms,missed and delayed diagnosis are common,resulting in high mortality rate.Timely diagnosis and effective treatment can improve the survival rate.

Objective To study the psychological experience of the primary caregivers of patients with lower extremity deep vein thrombosis in Department of Neurosurgery, and to provide the basis for the establishment of nursing intervention measures under the cultural background of China. Methods By using qualitative phenomenological research method, 13 caregivers of patients with lower extremity deep vein thrombosis in Department of Neurosurgery were semi structured interviewed from May to October in 2017, and data were analyzed by using Colaizzi method. Results In the end, 4 themes were generated. They were psychological response at the beginning of diagnosis, the pressure in the process of care, changes in social adaptation ability and coexistence of difficulties and hopes. Conclusions The mood of caregivers is directly related to the physical and mental health of patients with lower extremity deep vein thrombosis. When interviewing patients, medical staff should give more knowledge of disease and psychological counseling to their caregivers to reduce the uncertainty of disease, release the burden of primary caregivers and ultimately promote them recovery.

Objective: To evaluate the consistency of transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) method in monitoring cardiac volume load and cardiac hemodynamic indexes.Methods: A total of 45 patients undergoing coronary artery bypass grafting in our hospital were selected.The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were monitored during surgery by TEE and PAC respectively.Consistency of monitored data was compared between two methods.Results: Both TEE and PAC indicated that compared with baseline level, after loading, there were significant rise in RVEDV [TEE: (38±6)ml vs.(51±9ml), PAC: (153±17)ml vs.(188±19)ml], RVESV [TEE: (19±4)ml vs.(33±5)ml, PAC: (92±16)ml vs.(110±23)ml], P<0.01 all, but there was no significant change in RVEF, P>0.05.Before therapy, RVEDV, RVESV and RVEF monitored by PAC and TEE showed significant positive correlation, and all relevant coefficients were >0.8 (r=0.844, 0.862, 0.916, P<0.01 all);after therapy, correlation of RVEDV and RVESV significantly reduced to <0.6 (r=0.552, 0.579, P<0.05 both), but RVEF correlation remained >0.8 (r=0.892, P<0.01).Conclusion: In clinical monitor, the consistency of TEE and PAC is high,the former is non-traumatic,and is more convenient for clinical use.

Objective To observe the diagnostic value of high-sensitivity C-reactive protein/albumin ratio (hs-CRP/ALB) in early-onset infection in premature and its clinical significance. Methods Clinical data of premature patients with high risk factors of intrauterine infection admitted to neonatal intensive care unit (NICU) of Liaocheng People's Hospital in Shandong Province from July 2013 to July 2015 were analyzed retrospectively. They were divided into infection and non-infection groups, as well as survival and death groups according to the outcome of the premature babies. The pre-albumin (PA), ALB, white blood cell count (WBC), platelet count (PLT), and hs-CRP at the moment of NICU admission (0 hour) and 24, 48 and 72 hours after NICU admission were compared. The receiver operating characteristic (ROC) curve was plotted for evaluation of the predictive value of serum hs-CRP/ALB ratio for the babies during hospitalization. Results A total of 214 cases of premature infants were enrolled, with 102 cases in infection group, and 112 in non-infection group. In infection neonates, 97 of them survived, and 5 died. ① The level of hs-CRP after NICU admission was increased in infection and non-infection groups, and it was significantly higher at 48 hours in infection group than that of the non-infection group [mg/L: 22.0 (7.6, 40.4) vs. 18.3 (12.9, 23.4),Z = 5.257, P = 0.038]. Then hs-CRP was decreased in non-infection, but it was persistently increased in infection group, and it was significantly higher at 72 hours in infection group than that of the non-infection group [mg/L: 25.5 (9.8, 43.5) vs. 12.2 (1.9, 22.1), Z = 5.879, P = 0.042]. The levels of ALB and WBC in infection group was significantly lower than those of the non-infection group [ALB (g/L): 27.9±2.7 vs. 29.1±2.9, t = 5.178, P = 0.026; WBC (×109/L): 13.7±7.1 vs. 16.1±7.9, t = 4.368, P = 0.037], and at 48 hours hs-CRP/ALB in infection group was significantly higher than that of non-infection group [0.16 (0.08, 0.57) vs. 0.07 (0.00, 0.23), Z = 3.436, P = 0.042]. There was no significant difference in PA and PLT between infection and non-infection groups. ② In premature patients with infection, ALB in non-survival group was decreased (g/L: 20.4±6.9 vs. 29.6±7.5, t = 7.859, P = 0.003), and 48-hour hs-CRP and hs-CRP/ALB ratio was significantly increased when compared with that of survival group [hs-CRP (mg/L): 25.8 (15.6, 54.8) vs. 18.2 (12.9, 36.2), Z = 4.067, P = 0.043; hs-CRP/ALB: 0.31 (0.28, 0.76) vs. 0.06 (0.00, 0.21), Z = 6.102, P = 0.011].③ It was shown by ROC curve analysis that the area under ROC curve (AUC) of 48-hour hs-CRP/ALB ratio for evaluating infection was 0.765, when the cut-off of 48-hour hs-CRP/ALB ratio was 0.08, the sensitivity was 84.2%, and the specificity was 76.3%. Conclusions The values of hs-CRP and ALB can be used as effective indexes in early diagnosis of intrauterine bacterial infection, and increase in 48-hour hs-CRP/ALB can improve the sensitivity of the diagnosis. Hs-CRP/ALB can be combined to guide rational use of antibiotics.

BACKGROUND:The umbilical cord blood is rich in hematopoietic stem/progenitor cel s that have strong proliferation and differentiation ability as wel as ability to form colonies, and exert important roles in stimulating bone marrow function, improving blood cel viability and quantity, promoting immune cel maturation, and maintaining immune balance.
OBJECTIVE:To evaluate the clinical effects of autologous umbilical cord blood mononuclear cel transplantation on the immunologic function and prognosis for premature infants.
METHODS:Sixty-two preterm infants who entered into NICU immediately after birth, weighing ≤ 1 500 g, were divided into treatment group and control group according to parent’s wil ingness. In the treatment group, the umbilical cord blood was extracted from the umbilical vein and re-infused into the preterm infants after density gradient centrifugation within 4 hours. The cel ular immunity levels, humoral immunity levels and clinical parameters were monitored before and after treatment.
RESULTS AND CONCLUSION:After 1 week of treatment, the CD4, CD4/CD8 levels were significantly increased compared with the control group (P=0.01, 0.03), but CD8 level had no changes. At 1 week after treatment, IgM levels were both increased in the two groups, especial y in the control group (P=0.00);IgA levels had no changes;IgG levels were decreased, especial y in the control group (P=0.02). The incidence of severe infection during hospitalization was 13%in the treatment group, which was lower than the control group (16%), but there was no difference between the two groups. The proportion of infants undergoing mechanical ventilation and average length of stay had significant differences between the two groups (P<0.05). After 12 months, the incidence of recurrent respiratory tract infections was zero in the treatment group and one case in the control group, and there was a significant difference between the two groups. These findings indicate that autologous umbilical cord blood mononuclear cel transplantation can improve the immunologic function, slower the reduction of IgG levels, reduce the usage of breathing machine, shorten the length of stay, and reduce the incidence of recurrent respiratory tract infections in preterm infants.