Objective:To observe the effect of contralateral needling to regulate tendons and circulate Qi combined with Maitland joint mobilization on ankle joint function and the peri-ankle muscle groups in patients with chronic ankle sprain.Methods:A total of 77 patients with chronic ankle sprain,meeting the inclusion criteria,were randomly divided into a control group(38 cases)and an observation group(39 cases).The control group received conventional acupuncture treatment,while the observation group received contralateral needling to regulate tendons and circulate Qi combined with joint mobilization.Both groups were treated once daily for two consecutive courses.The American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scale was used to assess ankle joint function in the two groups,and the biomechanical model of skeletal muscles of lower limbs(Gait2392_simbody)was used to evaluate the muscle strength of the peri-ankle muscle groups.Results:The total effective rate in the observation group was 94.9%,significantly higher than the 79.0%in the control group(P<0.05).After treatment,the AOFAS ankle-hindfoot scores in both groups increased compared to their respective pre-treatment scores(P<0.05),and the scores in the observation group were higher than those in the control group(P<0.05).After treatment,the maximum muscle strength values of the medial and lateral heads of the gastrocnemius,tibialis posterior,and flexor hallucis longus in both groups increased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The maximum muscle strength values of the soleus and flexor digitorum longus in both groups decreased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were lower than those in the control group(P<0.05).The maximum muscle strength values of the extensor hallucis longus and tibialis anterior in both groups increased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The visual analog scale(VAS)score in both groups decreased compared to their respective pre-treatment score(P<0.05),and the score in the observation group was lower than that in the control group(P<0.05).Conclusion:Either the combined therapy(contralateral needling to regulate tendons and circulate Qi combined with joint mobilization)or the conventional acupuncture alone can alleviate pain,improve ankle joint function,and enhance the muscle strength of the peri-ankle muscle groups in patients with chronic ankle sprain,but the combined therapy shows superior efficacy.

The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has been gradually rising in recent years.According to published findings,high triglyceride levels are strongly associated with the severity of acute pancreatitis,and may lead to a higher incidence of complications and worse prognosis.However,the risk factors associated with HTG-AP have not been systematically explored.Early identification and effective management of high triglyceride levels and other potential causes thereof are crucial for reducing the recurrence of acute pancreatitis in clinical practice.Herein,we reviewed the predictive factors of HTG-AP from the perspectives of etiology,pathogenesis,and the relevant biomarkers,such as C-reactive protein,Ca2+,PT,and D-dimer.We aim to provide important early warning signals for clinicians,thereby helping develop personalized treatment protocols and building a more accurate risk prediction model.

Objective:To observe the effect of contralateral needling to regulate tendons and circulate Qi combined with Maitland joint mobilization on ankle joint function and the peri-ankle muscle groups in patients with chronic ankle sprain.Methods:A total of 77 patients with chronic ankle sprain,meeting the inclusion criteria,were randomly divided into a control group(38 cases)and an observation group(39 cases).The control group received conventional acupuncture treatment,while the observation group received contralateral needling to regulate tendons and circulate Qi combined with joint mobilization.Both groups were treated once daily for two consecutive courses.The American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scale was used to assess ankle joint function in the two groups,and the biomechanical model of skeletal muscles of lower limbs(Gait2392_simbody)was used to evaluate the muscle strength of the peri-ankle muscle groups.Results:The total effective rate in the observation group was 94.9%,significantly higher than the 79.0%in the control group(P<0.05).After treatment,the AOFAS ankle-hindfoot scores in both groups increased compared to their respective pre-treatment scores(P<0.05),and the scores in the observation group were higher than those in the control group(P<0.05).After treatment,the maximum muscle strength values of the medial and lateral heads of the gastrocnemius,tibialis posterior,and flexor hallucis longus in both groups increased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The maximum muscle strength values of the soleus and flexor digitorum longus in both groups decreased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were lower than those in the control group(P<0.05).The maximum muscle strength values of the extensor hallucis longus and tibialis anterior in both groups increased compared to their respective pre-treatment values(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The visual analog scale(VAS)score in both groups decreased compared to their respective pre-treatment score(P<0.05),and the score in the observation group was lower than that in the control group(P<0.05).Conclusion:Either the combined therapy(contralateral needling to regulate tendons and circulate Qi combined with joint mobilization)or the conventional acupuncture alone can alleviate pain,improve ankle joint function,and enhance the muscle strength of the peri-ankle muscle groups in patients with chronic ankle sprain,but the combined therapy shows superior efficacy.

Objectives:To investigate the risk factors of early postoperative complications in patients with a-cute subaxial cervical spinal cord injury after anterior bone grafting and fusion surgery.Methods:The clinical data of 168 cases of traumatic cervical spinal cord injury who underwent anterior surgery in our hospital from January 2017 to November 2021 were retrospectively analyzed.There were 133 males and 35 females.The age ranged from 23 to 82 years,with an average age of 53.8±11.2 years.There were 33 patients with preop-erative comorbidities(19.6％).ASIA classification of preoperative neurological impairment was as follows:34 patients of grade A,10 patients of grade B,62 patients of grade C,and 62 patients of grade D.50 patients were treated with high-dose methylprednisolone(29.8％).135 cases(80.4％)were treated with anterior cervical discectomy and fusion(ACDF),and 33 cases(19.6％)were treated with anterior cervical corpectomy and fusion(ACCF).Early postoperative complications and death of patients during hospitalization period were collected.Univariate logistic regression analysis was used to evaluate possible relationships between early postoperative complications and the factors including sex,age,preoperative comorbidities,cause of injury,neurological level of injury,preoperative ASIA grade,whether there was brain,thoracic and abdominal injury,whether high-dose methylprednisolone treatment was used,time from injury to surgery,preoperative hemoglobin(HGB),preopera-tive albumin(ALB),extent of surgery,surgical method,operative time,and intraoperative blood loss.A multi-variate logistic analysis was performed on the variables with P＜0.2 in the univariate analysis to identify signif-icant independent risk factors.Results:The incidence of early postoperative complications was 29.1％(49/168).Univariate logistic regression analysis showed that the cause of injury(P=0.032),preoperative ASIA grade(P＜0.001),whether combined with brain,thoracic and abdominal injury(P=0.043),whether high-dose methylpred-nisolone treatment was used(P=0.017),preoperative HGB(P=0.002),preoperative ALB(P=0.001)and surgical method(P=0.002)were correlated with early postoperative complications.Multivariate logistic regression analysis showed that preoperative ASIA grades A and B(P＜0.001,OR=5.389,95％CI 2.243-12.950)and high-dose methylprednisolone treatment(P=0.044,OR=2.541,95％CI 1.024-6.303)were independent risk factors for early postoperative complications.Conclusions:Preoperative ASIA grades A and B and high-dose methylpred-nisolone treatment are the independent risk factors for early postoperative complications in patients with acute subaxial cervical spinal cord injury.

Objective To construct and validate a clinical prediction model for delayed extubation undergoing non-emergency major surgery based on the random forest algorithm.Methods Clinical data of 7 528 patients undergoing non-emergency major surgery under general anesthesia from January 2018 to De-cember 2022 were retrospectively collected.The patients were divided into two groups according to whether extubation was performed within 2 hours after surgery:non-delayed extubation group(≤2 hours)and de-layed extubation group(＞2 hours).All the patients were randomly divided into a training set and a valida-tion set in a ratio of 7 ∶ 3.The predictive factors for delayed extubation after surgery were screened through LASSO regression and Logistic regression.The random forest model was established and verified by random forest algorithm.Results There were 123 patients(1.6%)experienced delayed extubation after surgery.ASA physical status,department,intraoperative use of flurbiprofen ester,dexmedetomidine,glucocorticoid,hypocalcemia,severe anemia,intraoperative blood transfusion,and airway spasm were identified as inde-pendent predictive factors for delayed extubation.The area under curve(AUC)value of the random forest prediction model in the validation set was0.751(95%CI0.742-0.778),and the sensitivity was98.1%,and the specificity was 41.9%.Conclusion The predictive model of delayed extubation undergoing non-e-mergency major surgery based on random forest algorithm has a good predictive value,which may be helpful to prevent delayed extubation undergoing non-emergency major surgery.

Capillary leak syndrome(CLS)is a group of clinical syndromes which caused by various causes of capillary endothelial damage, increased vascular permeability, resulting in a large amount of plasma protein infiltration into the interstitial space.It is one of the common critical cases in Neonatal Intensive Care Unit.As the complicated pathogenesis, blurred clinical stage and often neglected due to other complications, clinical treatment of CLS is difficult.Currently, there is no uniform diagnostic criteria, and the diagnosis is mainly based on clinical manifestation and laboratory examination.The treatment of it is empiric but no specific treatment.Primary disease treatment and fluid management are the critical parts of the treatment of CLS.Now, the etiology, pathogenesis, clinical diagnosis and treatment of the disease were explained combined with the domestic and foreign literature and clinical diagnosis and treatment practices, which aims to improve clinicians′ understanding of the disease and the level of clinical diagnosis and treatment.

Objective: To study the clinical characteristics, image findings, therapeutic method and prognosis of metanephric adenoma. Method: The clinical characteristic, image findings, operation methods and prognosis of 16 metanephric adenoma patients treated at Department of Urology, Peking University First Hospital from January 2004 to March 2016 were analyzed retrospectively. Results: There were 6 male and 10 female patients in the study. The mean age of patients was 33.7 years (ranging from 14 to 83 years). Two patients came to the hospital because of fever, while other 14 patients had no symptoms and found renal tumor by medical examination. One case was found polythemia vera and another 1 case showed mild anemia. Serum creatine of all the cases were in normal range. The tumor of 11 cases were at left side and 5 cases were at right. All patients took urinary tract ultrasound. Fifteen patients took CT examination. Among them, 14 cases were solid mass and 1 case was cystosolid.CT value was (41±4) HU. CT scan showed that the tumor was slight enhanced and CT value increased to (77±9) HU. Six patients took MRI examination. The MRI showed high or low signal of T1WI or T2WI scans.Tumor size was (4.7±3.9)cm (ranging from 1.7 to 17.5 cm). All 16 patients took operation and 11 of them took laparoscopic surgery while the other 5 cases took open surgery. Eleven cases took partial nephrectomy, 4 cases took nephrectomy and 1 case took nephroureterectomy. The surgical procedures were all successful and no complications occured during perioperative period. All cases were all confirmed metanephric adenoma by postoperative pathology and surgery cut edge were all negative. Immunohistochemical study showed that the positive rate of Vimentin, CD57, AE1/AE3, WT1, CK7 and AMACR respectively were 16/16, 15/16, 12/16, 10/16, 3/16 and 2/16. The median follow-up time of 16 cases was 44 months (ranging from 8 to 125 months) and none had recurrence or metastasis.One case died 125 months after surgery because of advanced age(83 years old). Conclusions Metanephric adenoma is difficult to be diagnosed relying on clinical characteristics and image features. Pathology can help confirm the diagnosis. Partial nephrectomy is the first choice for operation and can achieve good prognosis. But it still needs a regular follow-up.

Objective SGA and IURG fetuses are important risk factors for metabolic disease in adulthood,but the mechanism is not clear.In this study,Irisin levels in umbilical cord blood of different birth weight and IURG neonates were measured and the relationship between Irisin and neonatal weight,gestational age and other factors was explored.Methods This study was conducted in the cross-sectional study of neonates born in our hospital from 2014 to 2016.Newborns were divided into small-for-gestational age (SGA),greater-than-gestational age (LGA),gestational age (AGA) and newborns with intrauterine growth restriction (IUGR).The levels of irisin in umbilical cord blood of 4 newborns were detected.Results In this study,there were a total of 110 cases of newborns.The mean gestational age and mean birth weight of newborns in the SGA group was lower than that in the other three groups(P =0.000).The mean Irisin levels in the SGA and IUGR groups [54.4(45.6-66.7) ng/ml,53.7 (40.3-62.4) ng/ml] were significantly lower than those in the AGA group [67.7 (53.8-78.1) ng/ml,64.7 (53.6-71.2) ng/ml] (P =0.000).The mean insulin levels in the LGA group [7.54(0.83-58.96)mIU/ml] were significantly higher than those in the AGA group [38.00(34.40-39.30)mIU/ml] and IU-GR [3.86(0.49-16.15)] and SGA [4.19 (0.62-14.42)mIU/ml] (P =0.000).In the present study,the correlation analysis showed that Irisin level in neonatal umbilical cord blood was significantly correlated with neonatal gestational age (r =0.22,P ＜ 0.01),fetal weight (r =0.17,P ＜0.01) and maternal age (r =-0.12,P =0.021).However,only in the LGA group,the level of Irisin in cord blood of neonates was positively correlated with insulin level (r =0.41,P =0.042).Multivariate linear regression analysis revealed that SGA (β =-0.14,P =0.02) and fetal weight (β =0.05,P =0.008) were independent risk factors for neonatal umbilical cord blood Irisin levels.Conclusion There was a positive correlation between irisin level and neonatal umbilical cord blood birth weight.The levels of irisin in the neonates of the SGA and IURG groups were significantly lower than those of the AGA and LGA groups,but irisin levels did not differ between the SGA and IURG groups and between AGA and LGA groups.And irisin levels in the LGA group were positively correlated with insulin levels.Our results also reveal that singleton infants of mothers with preeclampsia had lower cord blood irisin levels compared to infants of mothers without preeclampsia.

Objective: To study the impact to operation safety of preoperative renal artery embolization for management of ≥10 cm renal cell carcinoma. Methods: The clinical data of 239 cases with ≥10 cm renal cell carcinoma which all had underwent operation in Department of Urology, Peking University First Hospital from January 2002 to December 2014 were retrospectively analyzed. Fifty-three patients underwent preoperative renal artery embolization (therapeutic group) and 186 patients did not (control group). The effect of embolization on operative time, transfusion requirements, hospitalization, ICU stay and perioperative complications were analyzed by comparing the two groups using rank sum test and χ² test or Fisher exact test. Results: Comparing the therapeutic group and control group, there was significant difference in tumor location (on the left or right). The mean age, sex, mean primary tumor size, and TNM stage were similar in both groups. Comparing the therapeutic group and control group, there were more open surgeries in therapeutic group (96.2% vs. 82.3%, χ²=6.438, P=0.013). There were no significant differences in mean operative time (238 (525) minutes vs. 208 (583) minutes, Z=-2.182, P=0.062). The mean blood transfusion (700 (1 900) ml vs. 925 (8 800) ml, Z=-1.064, P=0.006) had significant difference. The therapeutic group had a longer mean hospitalization (21 (50) days vs. 15 (79) days, Z=-4.322, P=0.000) and higher rate of intensive care unit stay (54.7% vs. 34.4%, χ²=6.103, P=0.027). There was no significant difference in perioperative complications between two groups (0 vs.3.2%, P=0.408). Conclusion Preoperative renal artery embolization in ≥10 cm renal cell carcinoma patients undergoing operation provides benefit in increasing operation safety and reducing perioperative death.

Objective: To investigate the clinical features and prognosis of rare subtypes of renal cell carcinoma. Methods: This retrospective study collected the data of 52 rare subtypes of renal cell carcinoma of patients who underwent surgery from January 2002 to December 2014 at Department of Urology, Peking University First Hospital. There were 12 patients with collecting duct carcinoma, 5 patients with Xp11.2 translocation renal cell carcinoma, 5 patients with mucinous tubular and spindle cell carcinoma, 30 patients with unclassified renal cell carcinoma. The study group included 25 male and 27 female patients, with mean age of 52 years. The mean tumour size was (6.5±3.9) cm (range: 1.5 to 21.0 cm). The basic clinical features, gross appearance, Fuhrman nuclear grade, TNM staging and prognosis of rare subtypes of RCC were studied. The OS curves were obtained for rare subtypes of renal cell carcinoma using the Kaplan-Meier method and compared using a Log-rank test. Results: The rate of lymph node and distant metastasis were 34.6% (18/52) and 17.3% (9/52). Malignancies were screened and detected by color Doppler ultrasonography or CT scan, however, no case was diagnosed before operation or aspiration, all cases were confirmed by the pathological examination. The average period of postoperative follow-up process was 65 months, and the mean survival time was (34±23) months. Conclusion The clinical features of rare subtypes of renal cell carcinoma are similar to those of clear cell renal cell carcinoma, while the imaging changes will be helpful for diagnosis before operation.