Objective To explore the efficacy of internal fixation of TightRope buckle steel plate with robot assistance for acute acromioclavicular joint dislocation.Methods From October 2022 to December 2023,17 patients with acute acromioclavicular dislocation admitted to our hospital were treated with robot assisted TightRope buckle steel plate fixation.According to the Rockwood classification,there were 2 patients with type Ⅱ and 15 patients with type Ⅲ.Preoperative planning was carried out by the robot's"super brain".During the surgery,under the guidance of the robotic arm,a hole was drilled from the clavicle to the coracoid process,and one end of the loop steel plate was pushed into the coracoid process to tighten the tail line,achieving the goal of resetting the acromioclavicular joint.Results The operations were successfully completed in all the 17 patients,with an operation time of 15-42 min(mean,27.9 min)and intraoperative blood loss of 5-25 ml(mean,10.4 ml).Postoperative DR showed that the acromioclavicular joint had been reduced.All incisions healed in one stage without any vascular or nerve related complications.On the second day after surgery,CT evaluation showed that the accuracy of clavicle drilling position was excellent in 12 cases and good in 5 cases and accuracy of coracoid process drilling was excellent in 9 cases,good in 7 cases,and poor in 1 case.All the 17 patients were followed up for 6-12 months,with an average of 10.4 months.On the second day and six months after surgery,there were no significant differences in the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected and healthy side[0.15(0.00,0.50)mm vs.-0.40(0.70,0.70)mm,Z=-1.553,P=0.120;0.15(0.00,0.50)mm vs.0.20(-0.25,0.85)mm,Z=-0.466,P=0.641].At six months after surgery,the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected side was significantly higher than on the second day[0.20(-0.25,0.85)mm vs.-0.40(0.70,0.70)mm,Z=-3.426,P=0.001].On the second day after surgery,the Visual Analogue Scale(VAS)score was 3.0(3.0,4.0)points,significantly lower than the preoperative score of 4.0(3.5,5.5)points(Z=-2.716,P=0.007).On the sixth month,the VAS score was1.0(0.0,1.5)points,significantly lower than the preoperative score(Z=-3.649,P=0.000)and on the second day after surgery(Z=-3.672,P=0.000).At the last follow-up,the Constant Murley score for shoulder joint function ranged 91-100 points,with an average of 94.3 points,all of which were excellent.The American Shoulder and Elbow Surgeons(ASES)score ranged 87-100 points,with an average of 96.7 points,the excellent and good rate being 100%(15 cases were excellent and 2 cases were good).Conclusion The use of robot assisted TightRope buckle loop steel plate internal fixation technology for the treatment of acute Rockwood type Ⅱ and Ⅲ acromioclavicular dislocation has good therapeutic effects.

Objective To explore the efficacy of internal fixation of TightRope buckle steel plate with robot assistance for acute acromioclavicular joint dislocation.Methods From October 2022 to December 2023,17 patients with acute acromioclavicular dislocation admitted to our hospital were treated with robot assisted TightRope buckle steel plate fixation.According to the Rockwood classification,there were 2 patients with type Ⅱ and 15 patients with type Ⅲ.Preoperative planning was carried out by the robot's"super brain".During the surgery,under the guidance of the robotic arm,a hole was drilled from the clavicle to the coracoid process,and one end of the loop steel plate was pushed into the coracoid process to tighten the tail line,achieving the goal of resetting the acromioclavicular joint.Results The operations were successfully completed in all the 17 patients,with an operation time of 15-42 min(mean,27.9 min)and intraoperative blood loss of 5-25 ml(mean,10.4 ml).Postoperative DR showed that the acromioclavicular joint had been reduced.All incisions healed in one stage without any vascular or nerve related complications.On the second day after surgery,CT evaluation showed that the accuracy of clavicle drilling position was excellent in 12 cases and good in 5 cases and accuracy of coracoid process drilling was excellent in 9 cases,good in 7 cases,and poor in 1 case.All the 17 patients were followed up for 6-12 months,with an average of 10.4 months.On the second day and six months after surgery,there were no significant differences in the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected and healthy side[0.15(0.00,0.50)mm vs.-0.40(0.70,0.70)mm,Z=-1.553,P=0.120;0.15(0.00,0.50)mm vs.0.20(-0.25,0.85)mm,Z=-0.466,P=0.641].At six months after surgery,the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected side was significantly higher than on the second day[0.20(-0.25,0.85)mm vs.-0.40(0.70,0.70)mm,Z=-3.426,P=0.001].On the second day after surgery,the Visual Analogue Scale(VAS)score was 3.0(3.0,4.0)points,significantly lower than the preoperative score of 4.0(3.5,5.5)points(Z=-2.716,P=0.007).On the sixth month,the VAS score was1.0(0.0,1.5)points,significantly lower than the preoperative score(Z=-3.649,P=0.000)and on the second day after surgery(Z=-3.672,P=0.000).At the last follow-up,the Constant Murley score for shoulder joint function ranged 91-100 points,with an average of 94.3 points,all of which were excellent.The American Shoulder and Elbow Surgeons(ASES)score ranged 87-100 points,with an average of 96.7 points,the excellent and good rate being 100%(15 cases were excellent and 2 cases were good).Conclusion The use of robot assisted TightRope buckle loop steel plate internal fixation technology for the treatment of acute Rockwood type Ⅱ and Ⅲ acromioclavicular dislocation has good therapeutic effects.

Pure-tone audiometry can be performed to evaluate the type and degree of hearing loss， whose results can be divided into four types including low-frequency descending， high-frequency descending， flat descending and total deafness. The low-frequency descending type of sudden hearing loss （SHL） is more likely to be spleen deficiency and dampness exuberance， the high-frequency descending type is often due to yin deficiency of liver and kidney， the flat descending type is commonly associated with qi and blood depletion， and the type of total deafness is often linked to blood stasis. Our team has further developed a comprehensive diagnostic and therapeutic approach for SHL， emphasizing "the integration of disease and syndrome， the combination of acupuncture and herbal medicine， and dynamically administering treatment". Firstly， it advocates integrating disease diagnosis with syndrome differentiation. Secondly， it recommends combining acupuncture and herbal medicine， with local acupoints such as Ermen （TE 21）， Tinggong （SI 19）， Tinghui （GB 2）， and Yifeng （TE 17） used to unblock the auditory orifice， and herbal prescriptions tailored to the hearing curve patterns. For the low-frequency descending type， it is recommended to fortify the spleen and percolate dampness by taking distal points of spleen channel and stomach channel and using Shenling Baizhu Powder （参苓白术散）. For the high-frequency descending type， the method of nourishing kidney and calming liver is recommended， using distal points of kidney and liver channels and taking Erlong Zuoci Pills （耳聋左慈丸）. Regarding the flat descending type， tonifying qi and nourishing blood is advised， for which acupoints of Conception Vessel， spleen， stomach and large intestine channels can be needled， and Yiqi Congming Decoction （益气聪明汤） can be administered. For the total deafness type， it is recommended to activate blood and dissipate stasis， often with Xuehai （SP 10） and Geshu （BL 17） needled and Tongqiao Huoxue Decoction （通窍活血汤） administered. All these are conducted to treat the root and branch simultaneously. At the same time， it emphasizes the need to consider complex syndrome presentations and disease progression， dynamically analyze the disease causes and mechanisms， and adjust treatment according to the changing syndromes. In conclusion， this article is expected to inspire clinical diagnosis and treatment of SHL.

Hormonal receptor positive human epidermal receptor 2 negative (HR⁺/HER2^-) is the commonest molecular subtype of breast cancer (BC). Patients with HR⁺/HER2^- BC may manifest clinically a late recurrence whose BC metastasizes 10-15 years post-operatively. We report one case who presented with pulmonary mass in upper lobe of lung and Horner syndrome 16 years after BC surgery. FDG PET/CT suggested pulmonary malignancy but could not differentiate between primary or metastatic cancer when invasive biopsy was quite risky. Novel ¹⁸F-FES PET/CT facilitated the non-invasive functional diagnosis of estrogen-receptor positive (ER+) pulmonary metastasis of BC, and the patient experienced partial response (PR) after CDK4/6 inhibitor and aromatase inhibitor as endocrine therapy. This article reviews the diagnosis and treatment process of this case, to provide guidance for non-invasive global evaluation of ER status among metastatic HR⁺/HER2^- BC patients with ¹⁸F-FES PET/CT.

Objective This study aims to conduct an evidence-based analysis of the research progress and management status of the competence of clinical department heads and nurse managers in China,providing reliable references for further devel-oping their management research and improving the human resource management in Chinese hospitals.Methods The VIP,CNKI,WANFANG Chinese databases,online resources,and relevant official websites were searched to retrieve literature related to the competence of clinical department directors and nurse managers in China.Descriptive analysis was conducted using biblio-metrics and evidence-based principles and methods.Results A total of 82 articles were included,mainly focusing on the con-ceptual theories of clinical department directors and nurse managers,the construction of competence models,and application re-search.The research on the competence of clinical department directors and nurse managers in China started relatively late and showed a trend of initial growth followed by decline.The distribution of journals was relatively scattered,and the literature mainly came from higher education institutions and medical institutions.The research development has stagnated at the stage of empirical research and has not progressed to the stage of evaluative research.Conclusion The research on the competence of clinical de-partment directors and nurse managers in China is still in the stage of application and practice,lacking systematic research.It is mainly led by higher education institutions and medical institutions,and the attention from the national government in terms of competence of clinical department directors and nurse managers in hospitals needs to be strengthened.

Objective:To investigate the inhibitory effect of probiotics on cholesterol gallstone formation in mice fed a high-fat diet and its impact on leptin and intestinal flora.Methods:Forty 8-week-old female C57BL/6J SPF mice were obtained. After one week of adaptive feeding, the mice were randomly assigned to G-NS group ( n=10), G-Probiotics group ( n=10), L-NS group ( n=10), and L-Probiotics group ( n=10). The G-NS group and G-Probiotics group were fed with standard diet, while the L-NS group and L-Probiotics group received lithogenic diet. Additionally, the G-Probiotics group and L-Probiotics group received a probiotic solution (5×10 9 CFU/ml, 0.1 mL/10 g) by gavage, once daily for 8 weeks. The G-NS group and L-NS group received an equal volume of normal saline by gavage. After 8 weeks, the stone formation rate of mice was observed, the serum leptin, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) contents of mice were detected, feces were collected and DNA was extracted to analyze the diversity and abundance of intestinal flora in mice. Count data were presented as percentages, Fisher′s exact probability test was used for comparisons, and measurement data with normal distribution were presented as mean±standard divation ( ± s). One-way ANOVA was applied for inter-group comparisons, and the K-W rank sum test was utilized to analyze inter-group differences in the intestinal microbiota section. Results:No gallstone was found in the G-NS group and G-Probiotics group. The stone formation rates of the L-NS group and the L-Probiotics group were 100% and 60%, respectively, with statistical significance ( P<0.05). In the G-NS group, L-NS group, G-Probiotics group and L-Probiotics group the serum total cholesterol (TC) content were (2.03±0.34) mmol/L, (4.75±0.76) mmol/L, (1.64±0.49) mmol/L and (3.66±0.62) mmol/L, the serum low-density lipoprotein (LDL) cholesterol content was (0.57±0.10) mmol/L, (1.55±0.29) mmol/L, (0.73±0.37) mmol/L and (1.06±0.16) mmol/L, the serum leptin content was (6.77±0.76) μg/L, (19.24±3.97) μg/L, (3.21±1.32) μg/L and (11.67±1.05) μg/L. Comparison of serum TC and LDL: L-NS group was higher than G-NS group, L-NS group was higher than L-Probiotics group, L-Probiotics group was higher than G-Probiotics group, the difference was statistically significant ( P<0.01). Comparison of serum leptin showed that L-NS group was higher than G-NS group and L-Probiotics group, G-NS group and L-Probiotics group was higher than G-Probiotics group, the difference was statistically significant ( P<0.01). Compared with the control group, the intestinal flora diversity of mice in the simple high-fat diet group decreased, the relative abundance of harmful bacteria increased, and the relative abundance of beneficial bacteria decreased. After probiotics intervention, the intestinal flora diversity increased, the relative abundance of beneficial bacteria increased, and the relative abundance of harmful bacteria decreased. Conclusion:Probiotics can lower leptin levels and alleviate leptin resistance, decrease serum TC and LDL levels, and reduce cholesterol levels in bile, thus reducing cholesterol buildup in the gallbladder and preventing stone formation.

Objective To analyze the impact of feedforward control nursing intervention on emergence agitation and recovery quality in general anesthesia surgery patients. Methods A total of 118 patients undergoing general anesthesia surgery were selected by convenient sampling, and randomly divided into control group and observation group, with 59 patients in each group. The control group received routine nursing intervention during emergence anesthesia, while the observation group received feedforward control nursing intervention. The incidence of emergence agitation, recovery quality, pain condition, and nursing quality were compared between the two groups. Results The incidence of emergence agitation during emergence in the observation group was significantly lower than that in the control group (42.37% versus 69.49%, P < 0.05). The Richmond Agitation-Sedation Scale (RASS) scores, duration and frequency of agitation were lower or shorter in the observation group than those in the control group (P < 0.05). The observation group exhibited shorter time for spontaneous respiration recovery, eye opening, extubation, full consciousness, and stay in the postanesthesia care unit compared to the control group(P < 0.05). The Steward emergence score was higher in the observation group (P < 0.05). The postoperative pain score was lower, while nursing quality score was higher in the observation group than those in the control group(P < 0.05). Conclusion Feedforward control nursing intervention can reduce the incidence of emergence agitation in general anesthesia surgery patients, improve recovery quality, alleviate postoperative pain, and enhance nursing quality.

Glycyrrizae Radix et Rhizoma has high medicinal value and is widely used in compatibility. It is used most frequently in the compatibility of Chinese medicine prescriptions，and is known as ''Guolao''（national medicine） and "master of all medicines". The characteristic active ingredients are mainly liquitin，glycyrrizic acid，glycyrrizin，and licochalcone. In different compatibilities，based on traditional and modern pharmacological theories，the corresponding effect of Glycyrrizae Radix et Rhizoma are brought into play through different mechanisms. Based on the traditional pharmacology of Glycyrrizae Radix et Rhizoma for tonifying spleen，replenishing Qi，clearing heat，removing toxin，dispelling phlegm，relieving cough and pain，and harmonizing various medicines，this paper used herbal authentication to analyze its compatibility application and mechanism. It was found that Glycyrrizae Radix et Rhizoma played corresponding effect in compatibilities through "tonification"，"harmonization"，and "regulation". For example，Glycyrrizae Radix et Rhizoma was combined with tonics including Ginseng Radix et Rhizoma and Atractylodis Macrocephalae Rhizoma to tonify the five Zang-organs through its strong tonifying effect，combined with Paeoniae Radix Alba and Aconiti Lateralis Radix Praeparata to relieve emergencies and pains through harmonizing medicine power and properties，and combined with Rhei Radix et Rhizoma and Natrii Sulfas to reduce medicine intensity through regulating medicine properties and body characteristics. The application law and mechanism of the modern pharmacological compatibility of Glycyrrizae Radix et Rhizoma were analyzed by data mining and network pharmacology. It was found that the modern clinical formula was often compatible with Glycyrrizae Radix et Rhizoma for anti-inflammation，cardiovascular and cerebrovascular protection，anti-virus，and anti-tumor，Ephedrae Herba and Scutellariae Radix for anti-inflammation，Bambusae Caulis in Taenias，Salviae Miltiorrhizae Radix et Rhizoma，and Aurantii Fructus Immaturus for cardiovascular and cerebrovascular protection，and Ophiopogonis Radix and Chuanxiong Rhizoma for nerves protection. Meanwhile，the important targets of the characteristic ingredients were protein kinase B1 （Akt1），interleukin-6 （IL-6），tumor necrosis factor （TNF），and epidermal growth factor receptor （EGFR）. The important characteristic pathways such as tyrosine kinase inhibitor resistance pathway and cyclic guanosine monophosphate （cGMP）/protein kinase G （PKG） signal pathway played the role of cardiovascular and cerebrovascular protection，and proteoglycan pathway in cancer played a neuroprotective role. This study is expected to provide references for the rational compatibility and application of Glycyrrizae Radix et Rhizoma，as well as the compatibility application of Chinese medicine prescriptions.

OBJECTIVE: To observe the clinical effect of transforaminal endoscopy combined with interspinous fusion in the treatment of lumbar spinal stenosis with instability in the elderly. METHODS: From February 2018 to February 2019, 82 elderly patients with lumbar spinal stenosis and instability were divided into control group and observation group. In the control group, there were 23 males and 18 females;the age was (68.9±4.1) years;the course of disease was (14.1±5.7) months;there were 5 cases of single segment lesions and 36 cases of multi segment lesions;simple bacfuse interspinous fusion was used. In the observation group, there were 22 males and 19 females;the age was (69.1±4.0) years;the course of diseasewas (14.4±5.5) months;there were 6 cases of single segment lesions and 35 cases of multi segment lesions;they were treated with transforaminal endoscopic surgery combined with Bacfuse interspinous fusion. The clinical efficacy, visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA), Oswestry disability index (ODI), Lehmann lumbar function score, posterior disc height and intervertebral foramen height, complication rate and recurrence rate of the two groups were compared. RESULTS: The clinical efficacy of the observation group was better than that of the control group;the VAS score of the observation group was lower than that of the control group, the JOA score was higher than that of the control group, and the ODI index at 3 months after operation and at the last follow-up was lower than that of the control group, the Lehmann lumbar function score was higher than that of the control group;the posterior edge height of intervertebral disc and intervertebral foramen height were higher than those of the controlgroup;the incidence of complications and recurrence rate (4.9% and 0.0%) of the observation group were lower than those of the control group (19.5%, 9.8%), the difference was statistically significant ( CONCLUSION The clinical effect of transforaminal endoscopy combined with interspinous process fusion in the treatment of lumbar spinal stenosis with instability in the elderly is ideal. It can reduce postoperative pain, improve lumbar function, improve the height of posterior edge of intervertebral disc and intervertebral foramen, and reduce the incidence and recurrence rate. It is worthy of clinical promotion.
Aged ; Endoscopy ; Female ; Humans ; Intervertebral Disc Degeneration ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis/surgery* ; Treatment Outcome

Objective::To investigate the effect of Bletillae Rhizoma polysaccharide on the expressions of phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt) gene protein and its mediated cytokines interleukin-2 receptor (IL-2R) and interleukin-4 (IL-4) in gastric tissue of rats with gastric ulcer (GU). Method::Sixty SPF Wistar rats were randomly divided into blank group and model group.The GU model was replicated by direct acetic acid cauterization in model group.The GU model rats were randomly divided into five groups: model group, positive control group, and large, medium and small-dose Bletillae Rhizoma polysaccharide groups, with 10 rats in each group.Rats in blank group and GU model group were given 10 mL·kg^-1·d^-1 distilled water by gavage, rats in large, medium and small-dose groups were given 0.5, 0.25, 0.125 g·kg^-1·d^-1 Bletillae Rhizoma polysaccharide by gavage, while rats in positive control group were given 0.3 g·kg^-1·d^-1 ranitidine by gavage for 15 days.Serum nitric oxide (NO) content, pepsinase activity and cytokines IL-2R and IL-4 levels in rats of each group were measured by enzyme-linked immunosorbent assay (ELISA), PI3K and Akt mRNA expressions were detected by Real-time fluorescent quantitative polymerase chain reaction (Real-time PCR), and PI3K and Akt protein expressions were detected by Western blot. Result::Compared with the blank group, the contents and gene expressions of cytokines IL-2R and IL-4 in gastric tissue were significantly increased, and the PI3K and Akt genes and protein expressions were significantly increased, with statistical significance (P<0.01). Compared with GU model group, the content and gene expressions of IL-2R and IL-4 in large, medium and small-dose Bletillae Rhizoma polysaccharide groups were decreased significantly, and the PI3K and Akt gene and protein expressions were decreased significantly in large-dose Bletillae Rhizoma polysaccharide group, while those in large and medium-dose Bletillae Rhizoma polysaccharide groups were decreased significantly (P<0.05, P<0.01). Conclusion::Bletillae Rhizoma polysaccharide can protect gastric mucosa by down-regulating PI3K and Akt gene and protein expressions and inhibiting abnormal secretion of cytokines IL-2R and IL-4.