OBJECTIVE: To review the research progress on the lower limb biomechanical characteristics of patients with discoid lateral meniscus (DLM) injury after surgery. METHODS: By searching relevant domestic and international research literature on DLM, the postoperative characteristics of knee joint movement biomechanics, tibiofemoral joint stress distribution, lower extremity force line, and patellofemoral joint changes in patients with DLM injury were summarized. RESULTS: Surgical treatment can lead to varying degrees of changes in the lower limb biomechanical characteristics of patients with DLM injury. Specifically, the kinematic biomechanics of the knee joint can significantly improve, but there are still problems such as extension deficits in the affected knee joint. The peak stress of the tibiofemoral joint decreases with the increase of the residual meniscus volume, and the degree of change is closely related to the residual meniscus volume. Preserving a larger volume of the meniscus, especially the anterior horn volume, helps to reduce stress concentration. The lower extremity force line will deviate outward after surgery, and the more meniscus is removed during surgery, the greater the change in the lower extremity force line after surgery. There are conditions such as cartilage degeneration, position and angle changes in the patellofemoral joint after surgery. CONCLUSION The changes in the lower limb biomechanical characteristics after DLM injury are closely related to the choice of surgical methods and rehabilitation programs. However, the mechanisms of biomechanical changes in multiple lower limb joints and individual differences still need to be further studied and clarified.
Humans ; Biomechanical Phenomena ; Tibial Meniscus Injuries/physiopathology* ; Menisci, Tibial/physiopathology* ; Knee Joint/surgery* ; Lower Extremity/physiopathology* ; Patellofemoral Joint/physiopathology* ; Range of Motion, Articular ; Knee Injuries/physiopathology*

Objective To investigate the independent risk factors affecting the prognosis of chronic active antibody-mediated rejection (caAMR) after kidney transplantation. Methods A retrospective analysis was conducted on 61 patients who underwent renal biopsy and were diagnosed with caAMR. The patients were divided into caAMR group (n=41) and caAMR+TCMR group (n=20) based on the presence or absence of concurrent acute T cell-mediated rejection (TCMR). The patients were followed up for 3 years. The value of 24-hour urinary protein and estimated glomerular filtration rate (eGFR) at the time of biopsy in predicting graft loss was assessed using receiver operating characteristic (ROC) curves. The independent risk factors affecting caAMR prognosis were analyzed using the LASSO-Cox regression model. The correlation between grouping, outcomes, and Banff scores was compared using Spearman rank correlation matrix analysis. Kaplan-Meier analysis was used to evaluate the renal allograft survival rates of each subgroup. Results The 3-year renal allograft survival rates for the caAMR group and the caAMR+TCMR group were 83% and 79%, respectively. The area under the ROC curve (AUC) for predicting 3-year renal allograft loss was 0.83 ［95% confidence interval (CI) 0.70-0.97］ for eGFR and 0.78 (95% CI 0.61-0.96) for 24-hour urinary protein at the time of biopsy. LASSO-Cox regression analysis and Kaplan-Meier analysis showed that eGFR≤25.23 mL/(min·1.73 m²) and the presence of donor-specific antibody (DSA) against human leukocyte antigen (HLA) class I might be independent risk factors affecting renal allograft prognosis, with hazard ratios of 7.67 (95% CI 2.18-27.02) and 5.13 (95% CI 1.33-19.80), respectively. A strong correlation was found between the Banff chronic lesion indicators of renal interstitial fibrosis and tubular atrophy (P<0.05). Conclusions The presence of HLA class I DSA and eGFR≤25.23 mL/(min·1.73 m²) at the time of biopsy may be independent risk factors affecting the prognosis of caAMR.

ObjectiveTo investigate the mechanism by which Mingshi prescription regulates the retinal melanopsin-dopamine （Opn4-DA） axis in myopic mice to inhibit endoplasmic reticulum （ER） stress in the retina and sclera， thereby delaying axial elongation associated with myopia. MethodsSixty 4-week-old male SPF-grade C57BL/6J mice were randomly divided into a normal group， a form-deprived myopia group （FDM group）， an intrinsically photosensitive retinal ganglion cells ablation group （ipRGCs group）， a Mingshi Prescription group （MSF group， 5.2 g·kg^-1）， and an ipRGCs + MSF group （5.2 g·kg^-1）. Except for the normal group， all other groups underwent FDM modeling. Additionally， the ipRGCs and ipRGCs + MSF groups received retinal ipRGC ablation. Three weeks after modeling， the MSF and ipRGCs + MSF groups were administered Mingshi prescription via continuous gavage for six weeks. After refraction and axial length were measured in all mice， eyeballs were collected along with retinal and scleral tissues. Pathological and morphological changes in the retina， choroid， and sclera were observed using periodic acid-Schiff （PAS） staining. Western blot was employed to detect the relative protein expression levels of dopamine D1 receptor （DRD1）， C/EBP homologous protein （CHOP）， and glucose-regulated protein 78 （GRP78） in the retina， and CHOP and GRP78 in the sclera. Real-time PCR was used to detect the relative mRNA expression of Opn4， CHOP， and GRP78 in the retina， and CHOP and GRP78 in the sclera. Immunofluorescence staining （IF） was performed to detect the expression of Opn4 and DRD1 in retinal tissues. ResultsCompared with the normal group， the FDM group showed a significant myopic shift in refraction （P<0.05） and a significant increase in axial length （P<0.05）. The retinal layers were thinner， the number of ganglion cells was reduced， and collagen fibers in the sclera were loosely arranged with evident gaps. Opn4 and DRD1 protein and mRNA expression in the retina were significantly decreased （P<0.05）， while CHOP and GRP78 protein and mRNA expression in both retinal and scleral tissues were significantly increased （P<0.05）. Compared with the FDM group， the ipRGCs group exhibited further increases in myopic refraction and axial length （P<0.05）， more pronounced thinning and looseness in the retinal， choroidal， and scleral layers， lower expression of Opn4 and DRD1 protein and mRNA in the retina （P<0.05）， and higher expression of CHOP and GRP78 protein and mRNA in the retina and sclera （P<0.05）. Compared with the FDM group， the MSF group showed significantly reduced refractive error and axial length （P<0.05）， with improved cellular number， arrangement， and thickness in ocular tissues， increased Opn4 and DRD1 protein and mRNA expression in the retina （P<0.05）， and reduced CHOP and GRP78 protein and mRNA expression in both retina and sclera （P<0.05）. Similarly， the ipRGCs + MSF group showed significant improvements in terms of the above items compared with the ipRGCs group （P<0.05）. ConclusionMingshi Prescription delays myopic axial elongation and refractive progression by regulating the Opn4-DA axis in the retina of myopic mice， thereby inhibiting ER stress in the retina and sclera. This intervention promotes Qi and blood nourishment of the eyes， softens the fascia， and restores ocular rhythm.

In China's medical practice,the protection of patients'rights in pre-hospital emergency care still faces numerous challenges,with cases of infringement of patients'rights occurring frequently.By analyzing 71 cases of medical disputes on pre-hospital emergency care from the China Judgements Online from 2017 to 2024,this paper revealed several issues in the protection of patients'rights in this field,such as the lack of specialized legislation,unclear scope of patients,vague starting time point of the doctor-patient relationship,and insufficient protection of patients'basic rights.Based on these,this paper proposed countermeasures,including strengthening specialized legislation in the field of pre-hospital emergency care,clearly defining the scope of patients,establishing the specific contents of pre-hospital medical contracts,and increasing the protection of patients'basic rights,aiming to promote the construction of a more sound and systematic pre-hospital emergency care legal system.

Objective To investigate the therapeutic efficacy of Wenyang Yiqi Therapy,the method of warming yang and replenishing qi in traditional Chinese medicine(TCM),combined with Alendronate Sodium Vitamin D3 in the treatment of elderly patients with osteoporosis(OP)of the spleen-kidney yang deficiency syndrome,and to observe its effect on bone metabolism and serum inflammatory factors.Methods A total of 110 cases of elderly patients with OP of spleen-kidney yang deficiency syndrome who admitted to the Department of Orthopedics and Traumatology of Traditional Chinese Medicine of Wuxi Ninth People's Hospital from October 2021 to October 2023 were randomly divided into a trial group and a control group,with 55 patients in each group.The two groups were treated with Alendronate Sodium Vitamin D3,and additionally the trial group was treated with Wenyang Yiqi Therapy by using Chinese herbal medicines of Epimedii Folium,Astragali Radix,Ostreae Concha,Angelicae Sinensis Radix,Cyathulae Radix,Psoraleae Fructus,Taxilli Herba,etc.The course of treatment for the two groups covered three months.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,bone mineral density(BMD),Visual Analogue Scale(VAS)score of pain,bone metabolism indicators of β-C-terminal telopeptide of type 1 collagen(β-CTX),total procollagen type 1 N-terminal propeptide(PINP)and bone gla-protein(BGP),and serum inflammatory factor indicators of interleukin 6(IL-6)and tumor necrosis factor α(TNF-α)].After treatment,the clinical efficacy of the two groups of patients was evaluated.Results(1)After three months of treatment,the total effective rate of the trial group was 94.55%(52/55)and that of the control group was 74.55%(41/55),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the trial group was significantly superior to that of the control group(P<0.01).(2)After treatment,the scores of TCM symptoms of soreness and weakness in the waist and knee,aversion of cold with cold limbs,fatigue and tiredness,and nocturnal frequent polyuria in the two groups were decreased compared with those before treatment(P<0.05),and the decrease in the trial group was significantly superior to that in the control group(P<0.01).(3)After treatment,the BMD of patients in the two groups were increased(P<0.05)while the pain VAS scores were decreased compared with those before treatment(P<0.05),and the increase in BMD and the decrease in pain VAS score of the trial group were significantly superior to that of the control group(P<0.01).(4)After treatment,the serum levels of bone metabolism indicators of β-CTX and PINP in the two groups were decreased compared with those before treatment(P<0.05),and the serum BGP level was increased compared with that before treatment(P<0.05).And the decrease of the serum β-CTX and PINP levels as well as the increase of the serum BGP levels in the trial group were significantly superior to that in the control group(P<0.01).(5)After treatment,the serum levels of inflammatory factors of IL-6 and TNF-αof patients in the two groups were decreased compared with those before treatment(P<0.05),and the decrease in the trial group was significantly superior to that in the control group(P<0.01).Conclusion Wenyang Yiqi Therapy combined with Alendronate Sodium Vitamin D3 exerts certain efficacy in the treatment of elderly patients with OP of spleen-kidney yang deficiency syndrome.The combined therapy is effective on alleviating the symptoms such as soreness in the waist and legs,improving bone metabolism,increasing BMD,and inhibiting the inflammatory responses,which will provide evidence for the clinical treatment.

In China's medical practice,the protection of patients'rights in pre-hospital emergency care still faces numerous challenges,with cases of infringement of patients'rights occurring frequently.By analyzing 71 cases of medical disputes on pre-hospital emergency care from the China Judgements Online from 2017 to 2024,this paper revealed several issues in the protection of patients'rights in this field,such as the lack of specialized legislation,unclear scope of patients,vague starting time point of the doctor-patient relationship,and insufficient protection of patients'basic rights.Based on these,this paper proposed countermeasures,including strengthening specialized legislation in the field of pre-hospital emergency care,clearly defining the scope of patients,establishing the specific contents of pre-hospital medical contracts,and increasing the protection of patients'basic rights,aiming to promote the construction of a more sound and systematic pre-hospital emergency care legal system.

Objective: In the background of endometrial hyperplasia triggered by obesity and estrogen, could the perilipin 2 (PLIN2) serve as a possible prognostic marker for early atypical endometrial hyperplasia (AEH)? Methods: A retrospective study examined blood lipid levels in endometrial cancer (EC) or AEH patients. An AEH mice model was established administrating with estradiol and/or high-fat (HF) diet. Hematoxylin and eosin staining were employed to assess pathological changes in the endometrium. Immunohistochemical staining were employed to evaluate the expression of adipose metabolism and endometrial hyperplasia proteins. The Cell Counting Kit-8 assay, cell colony-forming assays, and western blotting were utilized to verify the impact of oleic acid (OA) on HEC-1A cells. Results: The retrospective study revealed elevated blood lipid levels among patients with EC or AEH. Prolonged HF diet stimulated the endometrium to exhibit features of complex atypical hyperplasia. In the early stage, PLIN2 (p=0.006) expression significantly increased with endometrial glandular hyperplasia. Both PLIN2 (p=0.008) and progesterone receptor (PR; p=0.019) exhibited elevated expression concurrent with simple endometrial hyperplasia.When AEH occurred, there were notable rise in the expression of PLIN2 (p<0.001), PR (p=0.044), and estrogen receptor (p=0.045). The atypical hyperplasia glands demonstrated notably elevated PLIN2 expression in comparison to surrounding normal glands in AEH lesions. OA was found to enhance the proliferation and clonal formation of HEC-1A cells.HEC-1A cells induced by OA demonstrated elevated autophagy levels accompanied by enhanced expression of PLIN2. Conclusion PLIN2 may potentially serve as a biomarker for early development of AEH and EC, facilitating diagnosis and intervention and contributing to the determination of prognosis.

Objective To explore the early clinical outcomes of periacetabular osteotomy(PAO) in treating developmental dysplasia of the hip(DDH) in athletes.Methods A retrospective study was con-ducted on four active or retired athletes(two left and three right hips) diagnosed as DDH and undergo-ing PAO surgery at the Department of Sports Medicine of Peking University Third Hospital between January 2022 and October 2023.Among them,three received unilateral hip surgeries,while the rest one underwent bilateral surgery.The four patients had an average age of 27.25±4.97 years and a body mass index(BMI) of 23.91±2.07 kg/m2.Then their pre-and post-operative visual analogue scale (VAS) scores,modified Harris hip score(mHHS),hip outcome score activity of daily living(HOS-ADL) scores,and hip outcome score-sports scale(HOS-SS) scores were recorded and compared.Re-sults All patients went through the surgery successfully and completed the follow-up.Three of them were followed for 12 months,and the rest one for 8 months.After the operation,their average scores of mHHS,VAS,HOS-ADL and HOS-SS were 62.82±13.92,6.00±2.74,62.60±13.13 and 53.60±13.46,respectively,significantly higher than those before the operation,95.16±3.17,1.60±0.89,94.40±5.50,and 85.20±22.43 (P<0.05).Among the three active athletes,two patients (three hips) returned to competitive sports,with an average return-to-sport time of 9.7 months.Con-clusion PAO demonstrates good early clinical outcomes in treating DDH in athletes.

Objective:To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint (CMCJ) Eaton stage II/III arthrosis.Methods:A retrospective study was conducted on a total of 15 cases (16 hands) of patients including 5 males (1 bilateral) and 10 females with CMCJ stage II/III arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022, with mean age of 56.7±6.4 years (range, 46-75 years). The duration from pain to treatment was 7.8±3.2 months (range, 4-14 months). X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation. All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty. The preoperative and last postoperative follow-up radiographs, visual analogue scale (VAS), thumb's Kapandji scores, disabilies of the arm, shoulder, and hand (DASH) scores, grip and pinch strength and time to return to work were compared.Results:All cases were followed up for 19.6±6.3 months (range, 11-36 months). The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal. The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d. The average VAS score decreased from 6.56±1.15 preoperatively to 1.00 (0.75, 1.25). The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00 (7.25, 9.00). The average DASH values improved from 24.06±3.19 to 4.00 (3.00, 5.00). The were significant differences except for Kapandji score ( Z=-4.905, P<0.001; Z=-0.121, P=0.905; Z=-4.846, P<0.001). The mean grip and pinch strength showed improvement from an average of 16.4 (14.13, 18.68) kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference ( Z=-4.617, P<0.001; t=-7.669, P<0.001). Conclusion:Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage II/III arthrosis. By this technique, the patients' existing instability and pain problems can be solved.

Objective:To investigate the clinical efficacy of arthroscopic surgery for the treatment of femoral acetabular impingement (FAI) in athletes.Methods:A total of 18 FAI athletes (athlete group) who underwent hip arthroscopy in the Department of Sports Medicine, Peking University Third Hospital from April 2014 to June 2021 were retrospectively analyzed, including 12 males and 6 females, aged 20.44±3.45 years (range, 15-27 years). According to gender, age, body mass index and follow-up time, 36 non-athlete FAI patients (non-athlete group) were matched at a ratio of 1∶2 by propensity score matching method. There were 18 males and 18 females, aged 20.81±4.68 years (range 14-31 years). The hip pain visual analogue scale (VAS), modified Harris hip score (mHHS), hip outcome score-activity of daily living scale (HOS-ADL) and hip outcome score-sports scale (HOS-SS) scores were compared between the two groups before and after surgery. The minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were also compared between the two groups.Results:All patients successfully completed the surgery and were followed up for 33.56±19.20 months (range, 24-77 months). The VAS score at the last follow-up decreased from 6.22±1.52 points before surgery to 1.28±1.67 points in the athletes group, and decreased from 6.28±1.37 points before surgery to 1.67±1.69 points in the non-athletes group. There was no significant difference between the two groups ( P>0.05). The mHHS score at the last follow-up increased from 65.53±12.90 points before surgery to 92.28±13.59 points in the athletes group, and increased from 61.01±11.96 points before surgery to 86.82±11.98 points in the non-athletes group. There was no significant difference between the two groups ( P>0.05). The HOS-ADL score at the last follow-up increased from 72.77±18.86 points before surgery to 94.00±11.36 points in the athletes group, and increased from 70.35±13.12 points before surgery to 90.78±9.36 points in non-athletes group. There was no significant difference between the two groups ( P>0.05). The HOS-SS score at the last follow-up increased from 49.77±22.93 points before surgery to 87.28±17.62 points in the athletes group, and increased from 44.08±19.66 before surgery to 72.57±20.16 in the non-athletes group. The HOS-SS scores in the athletes group at the last follow-up were higher than those in the non-athletes group ( P<0.05). Furthermore, 61% (11/18) in the athletes group achieved MCID in HOS-ADL after surgery, which was lower than the non-athletes group's 81% (31/36), with a statistically significant difference (χ 2=4.339, P=0.037). Conclusion:Hip arthroscopy in the treatment of FAI in athletes can achieve satisfactory pain relief and motor function.