OBJECTIVE To evaluate the efficacy and safety of rituximab （RTX） in the treatment of primary Sjögren syndrome （pSS）. METHODS Randomized controlled trials （RCTs） on the effects of RTX （trial group） versus placebo （control group） in the treatment of pSS were searched from the Cochran Library， PubMed， Embase， Medline， Web of Science， VIP， CNKI， Wanfang， and other databases during the inception to February 2024. After literature screening and quality evaluation， meta-analysis was performed by using RevMan 5.3 software. RESULTS Seven RCTs were finally included， involving a total of 518 patients. Results of meta-analysis showed that European League Against Rheumatism Sjögren syndrome disease activity index （ESSDAI） score [MD＝－1.17， 95%CI（－1.52， －0.82）， P＜0.000 01] and oral dryness visual analogue scale （VAS） score [MD＝－3.97， 95%CI （－5.08， －2.86）， P＜0.000 01] in the trial group were significantly lower than the control group； unstimulated salivary flow rate [SMD＝0.64， 95%CI（0.41， 0.87）， P＜0.000 01] and Schirmer score [MD＝0.19， 95%CI（0.18， 0.20）， P＜0.000 01] were significantly higher than the control group. There was no statistical significance in response rate [RD＝0.10， 95%CI（－0.04， 0.23）， P＝0.16]， fatigue VAS score [MD＝－12.50， 95%CI（－35.14， 10.15）， P＝0.28]， European League Against Rheumatism Sjögren syndrome patient reported index （ESSPRI） score [MD＝0.33， 95%CI（－0.53， 1.18）， P＝0.46]， Short-form 36 health survey physical component summary （SF36-PCS） score [MD＝0.90， 95%CI（－2.97， 4.78）， P＝0.65]， SF-36 mental component summary （SF36-MCS） score [MD＝0.11， 95%CI（－0.41， 0.63）， P＝0.68]， total salivary gland ultrasound score [SMD＝－1.91， 95%CI（－4.01， 0.19）， P＝0.07] or the incidence of adverse drug reactions [OR＝1.15，95%CI（0.62，2.13），P＝0.66] between 2 groups. CONCLUSIONS RTX has advantages in the improvement of ESSDAI score， unstimulated salivary flow rate， Schirmer score and oral dryness VAS score in pSS patients， and has a good safety profile. However， it did not exhibit significant improvement in fatigue VAS score， ESSPRI score， SF36-PCS score， SF36-MCS score or response rates.

Objective:To explore the clinical efficacy and safety of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) techniques in treating recurrent lumbar disc herniation (RLDH).Methods:This study is a retrospective cohort study. The clinical data were retrospectively collected from 68 patients who underwent surgical treatment for RLDH at Department of Mini-invasive Spinal Surgery, the Third People′s Hospital of Henan Province from June 2020 to June 2023. The patients were divided into the UBE group (38 cases) and the PTED group (30 cases) based on the surgical technique used. The drainage volume, surgery duration, and postoperative complications for revision surgeries in both groups were recorded. Visual analogue scale(VAS) and Oswestry disability index (ODI) were used to assess back pain and leg pain degrees and improvements preoperatively, 3 days postoperatively, 3 months postoperatively, and at the final follow-up. The modified Macnab criteria were used to evaluate outcomes at the final follow-up. The data comparison was conducted using independent sample t-test, repeated measures analysis of variance, χ2 test or Fisher's exact test. Results:All surgeries were successfully completed. The surgery duration in the UBE group was significantly shorter than in the PTED group, with statistically significant differences ((50.9±10.5)minutes vs.(55.9±12.5)minutes, t=1.234, P=0.001). All patients were followed up for more than 1 year, with a follow-up period of (18.1±5.6) months (range: 12 to 29 months). Both groups showed a significant reduction in VAS and ODI for back and leg pain at all postoperative time points compared to preoperative scores (all P<0.05). However, there were no statistically significant differences in VAS of low back pain, lower limb pain score and ODI score over time between the groups (all P>0.05). At the final follow-up, the UBE group had an excellent and good rate of 92.1% (35/38); the PTED group had an excellent and good rate of 86.6% (26/30)( χ2=0.727, P=0.867). One patient in the UBE group and three in the PTED group experienced cerebrospinal fluid leaks, and one patient in the PTED group experienced postoperative leg numbness; all were discharged after conservative treatment. At the final follow-up, lumbar X-rays, CT, and MRI evaluations showed no recurrence or instability at the surgical segments. Conclusions:Both UBE and PTED can achieve good clinical outcomes in the treatment of RLDH through continuous visualization. The choice of surgical method for RLDH should be more precisely tailored to the individual.

OBJECTIVE To analyze the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treatment of carbapenem-resistant Acinetobacter baumannii(CRAB)pulmonary infection.METHODS A retrospective analysis was conducted on the clinical data of patients with CRAB pulmonary infection in our hospital from May 2021 to October 2024.Information such as age,gender,admitting department,infection status,underlying medical conditions,mechanical ventilation time,combination anti-infective treatment regimens,and the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)score 24 h before medication was compiled.Based on the effectiveness of the treatment,patients were divided into treatment-effective group and treatment-ineffective group.Univariate analysis and multivariate Logistic regression analysis were employed to identify independent factors influencing clinical efficacy.RESULTS A total of 156 patients were included,and 108 patients were treated effectively,with an effective rate of 69.23%.The results of univariate analysis indicated that there were statistically significant differences between 2 groups in terms of the duration of mechanical ventilation time,APACHE-Ⅱ score 24 h before medication,the number of complication types,the proportion of abnormal coagulation function,anti-infective treatment course,and hospital stay before medication(P＜0.05).The results of multivariate Logistic regression analysis showed that APACHE-Ⅱ score≥15 points 24 h before medication[OR=2.965,95%CI(1.284,6.845),P=0.020],mechanical ventilation time≥10 d[OR=3.577,95%CI(1.185,10.793),P=0.037]and hospital stay≥14 d before medication[OR=2.422,95%CI(1.036,5.654),P=0.041]were independent risk factors,and anti-infective treatment course＞7 d was a protective factor[OR=0.445,95%CI(0.221,0.895),P=0.043].CONCLUSIONS This study shows that the effective rate of polymyxin B combined with other antibiotics in the treatment of CRAB pulmonary infection is less than 70%.The mechanical ventilation time≥10 d,APACHE-Ⅱ score≥15 points 24 h before medication,and hospital stay≥14 d before medication may lead to treatment failure,whereas anti-infective treatment course＞7 d may be associated with treatment success.

Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

Objective:To explore the clinical efficacy and safety of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) techniques in treating recurrent lumbar disc herniation (RLDH).Methods:This study is a retrospective cohort study. The clinical data were retrospectively collected from 68 patients who underwent surgical treatment for RLDH at Department of Mini-invasive Spinal Surgery, the Third People′s Hospital of Henan Province from June 2020 to June 2023. The patients were divided into the UBE group (38 cases) and the PTED group (30 cases) based on the surgical technique used. The drainage volume, surgery duration, and postoperative complications for revision surgeries in both groups were recorded. Visual analogue scale(VAS) and Oswestry disability index (ODI) were used to assess back pain and leg pain degrees and improvements preoperatively, 3 days postoperatively, 3 months postoperatively, and at the final follow-up. The modified Macnab criteria were used to evaluate outcomes at the final follow-up. The data comparison was conducted using independent sample t-test, repeated measures analysis of variance, χ2 test or Fisher's exact test. Results:All surgeries were successfully completed. The surgery duration in the UBE group was significantly shorter than in the PTED group, with statistically significant differences ((50.9±10.5)minutes vs.(55.9±12.5)minutes, t=1.234, P=0.001). All patients were followed up for more than 1 year, with a follow-up period of (18.1±5.6) months (range: 12 to 29 months). Both groups showed a significant reduction in VAS and ODI for back and leg pain at all postoperative time points compared to preoperative scores (all P<0.05). However, there were no statistically significant differences in VAS of low back pain, lower limb pain score and ODI score over time between the groups (all P>0.05). At the final follow-up, the UBE group had an excellent and good rate of 92.1% (35/38); the PTED group had an excellent and good rate of 86.6% (26/30)( χ2=0.727, P=0.867). One patient in the UBE group and three in the PTED group experienced cerebrospinal fluid leaks, and one patient in the PTED group experienced postoperative leg numbness; all were discharged after conservative treatment. At the final follow-up, lumbar X-rays, CT, and MRI evaluations showed no recurrence or instability at the surgical segments. Conclusions:Both UBE and PTED can achieve good clinical outcomes in the treatment of RLDH through continuous visualization. The choice of surgical method for RLDH should be more precisely tailored to the individual.

Objective:To compare 3D-printing-assisted surgery and conventional surgery in the treatment of Schazker type Ⅵ tibial plateau fractures.Methods:A retrospective study was conducted to analyze the clinical data of 50 patients with type Ⅵ tibial plateau fracture who had been treated from January 2019 to December 2021 at the 5 Departments of Orthopedics in The First Affiliated Hospital of Nanchang University, The First People's Hospital of Jiujiang, Pingkuang General Hospital, Ganzhou People's Hospital, and Nanchang Hongdu Hospital of Traditional Chinese Medicine. The patients were divided into 2 groups according to their different treatment methods. In the 3D printing group of 25 cases treated by 3D-printing-assisted surgery, there were 14 males and 11 females, with an age of (42.5±9.1) years; in the conventional group of 25 cases treated by conventional surgery, there were 13 males and 12 females with an age of (42.2±9.3) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, fracture healing time, postoperative complications, the Rasmussen radiological scores and the American Hospital for Special Surgery (HSS) knee function scores at 6 and 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The operation time [(125.4±10.6) min], intraoperative blood loss [(206.2±16.3) mL], intraoperative fluoroscopy frequency [(9.2±2.7) times] and fracture healing time [(3.0±0.7) months] in the 3D printing group were all significantly less than those in the conventional group [(168.2±14.1) min, (303.2±20.4) mL, (15.5±3.5) times and (4.1±0.8) months] while the Rasmussen radiological scores (17.6±1.2 and 17.9±0.6) and HSS knee scores (90.8±6.4 and 91.5±5.6) at 6 and 12 months after operation in the 3D printing group were all significantly higher than those in the conventional group (16.2±2.6 and 16.7±2.2; 84.5±9.2 and 87.6±8.0) (all P<0.05). In the 3D printing group, there were 1 case of wound infection and 1 case of wound dehiscence after operation. In the conventional group, there were 2 cases of wound skin necrosis, 3 cases of wound dehiscence, 1 case of traumatic arthritis, 2 cases of wound infection, and 1 case of screw loosening. The incidence of complications in the 3D printing group (8.0%, 2/28) was significantly lower than that in the conventional group (36.0%, 9/25) ( P<0.05). Conclusion:In the treatment of Schatzker type VI tibial plateau fractures, compared with conventional surgery, 3D-printing-assisted surgery can lead to better curative outcomes, because it is conducive to lowering surgical difficulty, reducing postoperative complications, and promoting fracture union and functional recovery of the knee.

Objective:Reflux esophagitis (RE) may be negatively correlated with Helicobacter pylori ( H. pylori) infection, but the conclusion and relevant mechanism is still controversial. This study proposed to explore the correlation between RE and H. pylori infection based on natural population. Methods:From July 2013 to December 2014, 3 940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method. All the subjects underwent gastroscopy, and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry (WS) staining to identify H. pylori infection. Venous blood samples of some subjects were collected for H. pylori immunoglobulin G ( H. pylori-IgG) detection. Also, demographic and sociological data were collected. Chi-square test and logistic regression were used to analyze the correlation between RE and H. pylori infection. Results:A total of 359 cases of RE were detected. Excluding RE and other upper gastrointestinal organic diseases, 3 382 cases were considered as controls. Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group ( P=0.023), but there was no significant difference in the positive rate of H. pylori-IgG between the two groups ( P=0.281). There were significant differences between RE group and control group in gender composition, age, body mass index (BMI), smoking, alcohol consumption, education level and mucosal active inflammation. Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation [ OR=0.754 (95% CI 0.600-0.949), P=0.016], and positively correlated with male [ OR=4.231 (95% CI 3.263-5.486), P<0.001], age ≥60 years, BMI≥24 kg/m 2 [ OR=1.540 (95% CI 1.220-1.945), P<0.001]. Compared to those aged 40-49 years and 50-59 years, the odds ratio ( OR) of RE in these aged ≥60 years were 1.566 (95% CI 1.144-2.143, P=0.005) and 1.405 (95% CI 1.093-1.805, P=0.008). Conclusion:RE is more closely related to H. pylori present infection. Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H. pylori infection, and positively correlated with male, overweight and aged ≥60 years.

Objective: To explore the influence of adverse childhood experiences (ACEs) on pubertal development of boys and girls and to provide a reference for the development of intervention measures. Methods: A stratified cluster sampling method was used to select a total of 1 156 students in grades three and four in the boarding school system and public primary schools in Huangshan City and surrounding towns in September 2018, using the Childhood Trauma Questionnaire (CTQ) and the Pubertal Development Scale (PDS). For the baseline self-assessment survey, according to different dimensions, abuse children score no exposure groups. Children were divided into an exposure group and a high exposure level group, according to their childhood experiences. PDS self-report questionnaire was administered two years later, and an analysis of ACE type and severity of the continuous impact of youth development was conducted. Results: In the baseline survey, there were 53 girls (11.32%) and 51 boys (7.41%) who developed earlier. The rate of early development in girls was higher than that of boys, and the difference was statistically significant(χ 2=5.21, P<0.05). Univariate analysis showed gender differences in the effects of type and severity of ACEs and abuse on adolescent development at both baseline and follow-up. There were gender differences in the rate of early development between boys and girls at baseline and at follow-up between the exposure groups. Regression analysis showed that the higher the degree of emotional abuse, emotional neglect, and sexual abuse in girls, the higher the PDS score(B=0.22, 0.15, 0.08, P<0.05). In boys, the more severe the emotional abuse experienced, the higher the PDS score, and the more severe the physical abuse experienced, the lower the PDS score(B=0.20, 0.04, P<0.05). Conclusion Attention should be paid to the influence of ACEs and gender differences during youth development among male and female students, and more longterm studies should also be carried out.

Objective:To summarize the clinical effect of the optimized lateral supramalleolar perforator pedicle flap in repairing the soft tissue defect of the foot and ankle.Methods:From January 2016 to June 2019, the Microorthopaedics of the Second Affiliated Hospital of Luohe Medical College admitted 16 patients with small and medium area skin and soft tissue defects of the ankles, including 12 males and 4 females. The age ranged from 18 to 63, with an average age of 48. The defects was repaired with the optimized laterals uprmalleolus perforator pedicle flap. The width of the wound was measured preoperatively, and the anterolateral skin in the middle lower or middle part of the calf was evaluated by "lifting and kneading" according to the width of the wound. After the evaluation, the doner arear can be closed directly. The lateral supramalleolar perforating vessels and there proximal perforation of peroneal artery can be detected by Doppler ultrasound flowmeter. The line of two perforating points is used as the central axis of the flap. The rotation point of flap was at lateral malleolus plane or the superior edge of the inferior tibiofibular syndesmosis. The distance from the rotation point to the proximal edge of the wound was used as the pedicle length of the vsscular tissue. During the operation, the perforating branch in the pedicle of the flap and the descending branch in the terminal perforating branch of the peroneal artery should be protected. After the perforating vessels above the lateral supramalleolar perforating branch were clipped with vessel clips, the tourniquet was relaxed to evaluate the blood supply of the flap. If necessary, the interosseous membrane can be opened to carry the peronerl artery. The flap was transferred to the recipient area through the open channel which was optimized to cover the pedicle with a blunt curved or semicircular flap. In 4 patients with perimalleolar and plantar skin defects, the head end of the superficial peroneal nerve in the flap was anastomosed with the side of the recipient sural nerve. The donor area was closed directly. The survival of the flap was observed after operation.Results:In this group of 16 cases, the area of the flap was 3.0 cm×1.5 cm-14.0 cm×6.0 cm. Only 1 case of flap showed blood stasis and swelling at 24 h after surgery, with poor blood flow at the distal end. Although the pedicle suture was removed, one week later, the tip of the flap still showed small area of necrosis. After dressing changes later, it gradually heals. The other flaps survived without special treatment. 12 patients were followed up for 4 months to 2 years, and the flap shape and function were satisfactory. Among the 4 patients with nerve anastomosis, 3 of them were followed up for 8-13 months, 1 case recovered to grade S2, and 2 cases recovered to grade S3.Conclusions:Through the optimal selection of the flap donor area, the optimal design of the open channel, the evaluation of the blood supply of the flap and the optimal treatment of the perforating vessels, the survival rate of flap was not only improved, but also a good shape and function was obtained. Although some patients may have different degrees of sensory dysfunction of the dorsal foot after excision of the superficial peroneal nerve, it can still be regarded as one of the ideal method to repair the skin and soft tissue in the middle and small area of foot and ankle.

Objective:To summarize the clinical effect of the optimized lateral supramalleolar perforator pedicle flap in repairing the soft tissue defect of the foot and ankle.Methods:From January 2016 to June 2019, the Microorthopaedics of the Second Affiliated Hospital of Luohe Medical College admitted 16 patients with small and medium area skin and soft tissue defects of the ankles, including 12 males and 4 females. The age ranged from 18 to 63, with an average age of 48. The defects was repaired with the optimized laterals uprmalleolus perforator pedicle flap. The width of the wound was measured preoperatively, and the anterolateral skin in the middle lower or middle part of the calf was evaluated by "lifting and kneading" according to the width of the wound. After the evaluation, the doner arear can be closed directly. The lateral supramalleolar perforating vessels and there proximal perforation of peroneal artery can be detected by Doppler ultrasound flowmeter. The line of two perforating points is used as the central axis of the flap. The rotation point of flap was at lateral malleolus plane or the superior edge of the inferior tibiofibular syndesmosis. The distance from the rotation point to the proximal edge of the wound was used as the pedicle length of the vsscular tissue. During the operation, the perforating branch in the pedicle of the flap and the descending branch in the terminal perforating branch of the peroneal artery should be protected. After the perforating vessels above the lateral supramalleolar perforating branch were clipped with vessel clips, the tourniquet was relaxed to evaluate the blood supply of the flap. If necessary, the interosseous membrane can be opened to carry the peronerl artery. The flap was transferred to the recipient area through the open channel which was optimized to cover the pedicle with a blunt curved or semicircular flap. In 4 patients with perimalleolar and plantar skin defects, the head end of the superficial peroneal nerve in the flap was anastomosed with the side of the recipient sural nerve. The donor area was closed directly. The survival of the flap was observed after operation.Results:In this group of 16 cases, the area of the flap was 3.0 cm×1.5 cm-14.0 cm×6.0 cm. Only 1 case of flap showed blood stasis and swelling at 24 h after surgery, with poor blood flow at the distal end. Although the pedicle suture was removed, one week later, the tip of the flap still showed small area of necrosis. After dressing changes later, it gradually heals. The other flaps survived without special treatment. 12 patients were followed up for 4 months to 2 years, and the flap shape and function were satisfactory. Among the 4 patients with nerve anastomosis, 3 of them were followed up for 8-13 months, 1 case recovered to grade S2, and 2 cases recovered to grade S3.Conclusions:Through the optimal selection of the flap donor area, the optimal design of the open channel, the evaluation of the blood supply of the flap and the optimal treatment of the perforating vessels, the survival rate of flap was not only improved, but also a good shape and function was obtained. Although some patients may have different degrees of sensory dysfunction of the dorsal foot after excision of the superficial peroneal nerve, it can still be regarded as one of the ideal method to repair the skin and soft tissue in the middle and small area of foot and ankle.