ObjectiveTo systematically compare the effects of diverse electromagnetic stimulation protocols on hand function and activities of daily living (ADL) in stroke patients using network meta-analysis (NMA), and screen the optimal stimulation strategy for post-stroke hand dysfunction rehabilitation. MethodsNMA was performed in accordance with the PRISMA-NMA statement. Databases of CNKI, Wanfang data, VIP, CBM, PubMed, Web of Science and Embase were searched from database inception to April, 2026 for eligible randomized controlled trials (RCTs) comparing different electromagnetic stimulation protocols for post-stroke hand impairment. The Cochrane Risk of Bias tool and PEDro scale were used to assess methodological quality of included studies, while the GRADE system was adopted to grade evidence quality of primary outcomes of Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI). After literature screening, data extraction and bias evaluation, RevMan 5.4 and Stata 17.0 were used for meta-analysis and NMA. ResultsA total of 22 RCT involving 17 electromagnetic stimulation protocols were finally included. The PEDro scores ranged from six to ten. The top five protocols for improving FMA-UE score were repetitive peripheral magnetic stimulation (rPMS) + repetitive transcranial magnetic stimulation (rTMS), intermittent theta-burst stimulation (iTBS) + rPMS, iTBS + transcranial direct current stimulation (tDCS), transcutaneous electrical acupoint stimulation (TEAS) and contralaterally controlled functional electrical stimulation (CCFES). tDCS was the most effective on MBI, followed by TEAS and iTBS+rPMS. Evidence quality for FMA-UE and MBI was moderate. Funnel plots suggested low risk of publication bias, and consistency tests verified good coherence between direct and indirect comparisons in network models. ConclusionElectromagnetic stimulation significantly facilitates upper limb and hand functional recovery, and improves ADL in stroke patients. The combined central-peripheral magnetic stimulation protocol may be the most effective on motor rehabilitation, whereas tDCS on ADL.

ObjectiveBy analyzing the current situation of drug selection and evaluation in medical institutions in the world，we aim to understand the development of relevant selection methods and tools，provide reference basis for drug selection in traditional Chinese medicine （TCM） medical institutions，and promote the optimization of drug catalogs in TCM medical institutions. MethodBased on the method of scoping review，the eight databases were systematically searched，the included documents were screened，extracted and analyzed，and the research results were graphically displayed. ResultA total of 23 articles were included in this study，including 13 in Chinese and 10 in English，involving 23 methods or tools related to drug selection. Of the 14 methods or tools from Chinese medical institutions，the earliest one was published in 2012，and five were published in 2022. The published methods or tools involved different levels of hospitals，different drug varieties，different evaluation angles，etc.，such as the drug selection methods of one county hospital and one township hospital， methods and tools for different types of drugs such as antibacterial drugs，ibuprofen preparations，proton pump inhibitors and hypoglycemic drugs used in pediatric intensive care units， Chinese patent medicine selection tools， tools for evaluation from the perspective of pharmacoeconomics， and universal tools for selecting domestic medical institutions. The nine drug selection tools of foreign medical institutions were from the European，American，Asian and African countries. It was first published in 1955. The contents included the formulation standards that medical institutions should follow for drug prescription sets，the management formulation and update of hospital prescription sets，and drug evaluation tools. ConclusionOn the whole，the drug selection methods and institutional methods of foreign medical institutions developed earlier than those in China. In recent years，Chinese medical institutions have paid high attention to drug selection and released various types of drug selection tools. However，the standardization should be further improved in the future.

OBJECTIVE: To explore the genetic basis for a rare case with Disorder of sex development. METHODS: Clinical data of the patient was collected. Chromosomal karyotyping, SRY gene testing, whole exome sequencing (WES), low-coverage massively parallel copy number variation sequencing (CNV-seq), fluorescence in situ hybridization (FISH), and whole genome sequencing (WGS) were carried out. RESULTS: The patient, a 14-year-old female, had manifested short stature and dysplasia of second sex characteristics. She was found to have a 46,XY karyotype and positive for the SRY gene. No pathogenic variant was found by WES, except a duplication at Yp11.32q12. The result of CNV-seq was 47,XYY. FISH has confirmed mosaicism for a dicentric Y chromosome. A 23.66 Mb duplication on Yp11.32q11.223 and a 5.16 Mb deletion on Yq11.223q11.23 were found by WGS. The breakpoint was mapped at chrY: 23656267. The patient's karyotype was ultimately determined as 46,X,psu idic(Y)(q11.223)/46,X,del(Y)(q11.223). CONCLUSION The combination of multiple methods has facilitated clarification of the genetic etiology in this patient, which has provided a reference for the clinical diagnosis and treatment.
Female ; Humans ; Adolescent ; DNA Copy Number Variations ; In Situ Hybridization, Fluorescence ; Y Chromosome ; Sexual Development ; Mosaicism

Objective To investigate the clinical features of multiple ligament injuries of the knee joint, and evaluate the clinical efficacy of one-stage repair and reconstruction under an arthroscope of multiple ligament injured knee joint. Methods The clinical data were analyzed retrospectively of 22 patients receiving treatment and follow-up for multiple ligament injuries of the knee joint from March 2015 to June 2017 in the Henan Orthopedic Hospital. 13 males and 9 females aged from 24 to 64 years; and left knee injury occurred in 7 cases, right knee in 5 cases, all injuries were close with knee subluxation or dislocation. Imaging, clinical and arthroscopical examination showed anterior and posterior cruciate ligament ruptures in all the patients. The time from injury to operation was from 4 to 16 days, all the patients were treated by single tunnel and single beam reconstruction of anterior and posterior cruciate ligament under an arthroscope, limited incision and reconstruction of PMC (posterior medial complex) and PLC (posterior lateral complex); and the concurrent injuries were treated at that same time. Postoperative X-Ray and MRI were performed to determine the healing of bone tunnel, internal fixation, remodeling of reconstructed tendon and tendon healing. The knee function was assessed on the basis of the range-of-motion of the knee, IKDC score and Lysholm Knee Function score. Results All the patients were followed up from 6 to 14 months with an average of (11.0±1.5) months. The torn inner and outer meniscus and fracture were all healed and the deep venous thrombus was dissolved. Last follow up found varus and valgus stress test was normal or close to normal in 22 patients by Lachman test, anterior and posterior drawer tests were negative, and the tibial shift distance forward or backward was smaller than 5mm. The patients had no subjective symptoms. X-Ray and MRI showed that the tibial femoral tunnel had healed, and the position of internal fixation had no change, and the ligament had been reconstructed and the tendon had healed. In 2 cases, one year later, sensory and motor recovery was observed after common peroneal nerve injury. Range of motion of the knee joint, and Lysholm and IKDC scores were significantly superior at the last following up to at the preoperation (P<0.01); and IKDC comprehensive assessment revealed a normal result (A) in 4 cases, close to normal (B) in 16, abnormal (C) in 2, whereas they are significantly abnormal (D) at admission. Conclusion One-stage arthroscopical repair and reconstruction for multiple ligament injuries of the knee can obviously stabilize the knee joint, improve the knee joint function early, prevent postoperative complications, shorten the hospitalization time, reduce the cost, improve the quality of life, and have the advantages of safety, reliability and less trauma, and the clinical efficacy is satisfactory.

OBJECTIVETo explore clinical effect of arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint.

METHODSFrom July 2014 to December 2017, 33 patients with lateral meniscal cyst of knee joint were treated by arthroscopic cysts removal and wire-guided suture, including 13 males and 20 females, aged from 20 to 55 years old with an average age of(36.23 ±2.30) years old, the courses of disease ranged from 3 to 14 months with an average of(4.60±0.83) months; Preoperative MRI examination was clear diagnosed. There were 14 cysts on anterior horn, 18 cysts on meniscal body and 1 cyst on posterior horn;all cysts were solitary, and 3 of them were multilocular. Lysholm score and GLASOW score of knee joint function and clinical efficacy were observed before and after operation at 6 months.

RESULTSAll patients were followed up form 6 to 24 months with an average of (7.5±1.2) months. Preoperative symptoms disappeared or significantly alleviated, and all incisions were healed by intention without complication and neurovascular injury. MRI showed meniscal tear areas and cystic defective areas healed, cyst was not recurrenced, healing time ranged form 8 to 12 weeks with an average of (9.6±1.6) weeks, and patients recovered their daily life and exercise. There was significant difference in Lysholm score before operation (61.12±4.35) and after operation at 6 momths(91.32±3.36)(=46.11, <0.01);according to GLASOW assessment, 31 patients with excellent recovery, and 2 good.

CONCLUSIONSArthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint could reserve meniscus, repair injury of meniscus, recover knee joint function after operation, and is worth popularizing.

OBJECTIVETo explore the clinical efficacy of double-plate fixation for the treatment of old tibial plateau fractures with Schatzker type IV through anterior midline and posteromedial approaches.

METHODSFrom July 2013 to July 2015, 15 patients with old tibial plateau fractures were treated with internal fixation using locking reconstructive plate for the posteromedial fragment and anatomical locking plate for anteromedial fragment through antero midline and posteromedial approaches. There were 9 males and 6 females, with an average age of 49.2 years old (ranged, 21 to 61 years old). Eight patients had injured in the left side and 7 in the right side. According to Schatzker classification, all patients were type IV. The mean interval from injury to operation was 26.5 days (ranged, 21 to 65 days). The main clinical symptoms before operation were knee joint swelling, pain, deformity and limitation of motion. The X-ray and CT confirmed the fracture type. The indexes such as tibial plateau tibial shaft angle (TPA), femoral tibial angle (FTA) and posterior slope angle (PSA) were compared between immediate postoperation and final follow-up using postoperative X-ray film. The knee functions were evaluated using the HSS (Hospital for Special Surgery) knee score system.

RESULTSTwo patients had incision complications which healed by correct treatment, 1 patient had traumatic arthritis. All patients were followed up for mean 16.6 months (ranged, 13 to 24 months). No infections, deep venous thrombosis, implant loosening and breakage, fragment displacement, plateau surface collapse and bone nonunion found. The bone union time ranged from 3 to 8 months (mean 6.07 months) after operation. The average immediate postoperative value of TPA, FTA and PSA were(86.81±1.67)°, (168.00±3.29)° and(10.20±1.47)° respectively; and(86.47±1.67)°, (168.53±3.03)° and (10.54±1.21)° respectively at the final follow-up evaluation, showing no statistical differences(>0.05). According to the HSS score system, 26.33±3.86 in pain, 20.00±1.79 in function, 16.00±1.55 in range of motion, 8.67±0.94 in muscle strength, 8.53±1.67 in flexion deformity, 9.33±0.94 in joint stability, and the total mean score was 88.86±8.92. The outcomes were excellent in 10 cases, good in 4, and fair in 1.

CONCLUSIONSDouble-plate fixation via combined anterior midline and posteromedial approaches is an ideal surgical method for old tibial plateau fractures with Schatzker IV type, showing satisfactory exposure, reliable reduction and fixation, and benefiting for early functional exercise. The short-term clinical results was satisfactory.

Exercise-induced fatigue is a comprehensive response to a variety of physiological and biochemical changes in the body, and can affect people’s quality of life to different extents. If no timely recovery after occurrence of fatigue, accumulated gradually, it can lead to “burnout”, a “overtraining syndrome”, “chronic fatigue syndrome”, etc., which will cause endocrine disturbance, immune suppression, even physical illness. Exercise-induced fatigue becomes an important factor endangering human health. In recent years, many experts and scholars at home and abroad are committed to the research of exercise-induced fatigue, and have put forward a variety of hypothesis to explain the cause of exercise-induced fatigue. They expect to find out the methods for preventing and eliminating exercise-induced fatigue. This article discusses mainly the pathogenesis, model building, elimination/ relief, etc. of exercise-induced fatigue to point out the research achievements of exercise-induced fatigue and its existing problems.

Objective To observe the therapeutic effect of bone cement injectable pedicle screw system combined with intervertebral fusion for lumbar spondylolysis and osteoporosis. Methods The clinical data were analyzed retrospectively of 21 patients with lumbar spondylolysis and osteoporosis who received treatment of bone cement injectable pedicle screw system and interv ertebral fusion from Aug. 2013 to Nov. 2015. The 21 patients (9 males and 12 females) aged from 60 to 80 years (mean 64 years old); 6 of them presented degenerative spondylolysis, 15 with isthmic spondylolisthesis; 2 cases had I degree slippage, 13 had II degree slippage, 6 had III degree slippage, and all the cases were unisegmental slippage including 9 cases in L4 and 12 cases in L5. Bone mineral density of lumbar vertebrae (L2-L5) was measured with dual-energy X-ray absorptiometry, and T values conforming to the diagnostic criteria of osteoporosis were less than or equal to -2.5; All patients were operated with whole lamina resection for decompression, bone cement injectable pedicle screws system implantation, propped open reduction and fixation intervertebral fusion. The clinical outcomes were determined by the radiographic evaluation including intervertebral height, height of intervertebral foramen, slip distance, slip rate and slip angle, and Oswestry disability index (ODI) on preoperative, 3 months after operation and the end of the time, and the interbody fusion were followed up. Results Cerebrospinal fluid leakage of incision was observed in two cases after operation, compression and dressing to incision, Trendelenburg position, dehydration and other treatments were taken, and the stitches of incisions were taken out on schedule. Slips in the 21 patients were reset to different extent, and lumbar physiological curvatures were recovered. The intervertebral height and height of intervertebral foramen were obviously higher 3 months after operation than that before operation (P<0.05), and the slip distance, slip rate, slip angle and ODI scores were markedly shorter or smaller 3 months after operation than that before operation (P<0.05). Follow-up was done for 16-26 months (average of 20.5 months). All the judgment indexes mentioned above were statistically different in the last following up than that before operation (P<0.05), but no significant difference compared to that of 3 months after operation (P>0.05). Based on the ODI score, the excellent/fine rate was 90.6% and 92.5% for 3 months after operation and the last follow-up, respectively. During the period of following up, no loss of the correction degrees, no loosening of the screws, and 19 cases were noted bony fusion with the fusion success rate of 90.5%. Conclusion The treatment effect of bone cement injectable pedicle screw system and intervertebral fusion for lumbar spondylolysis and osteoporosis is satisfied.

Objective To observe the treatment effect of internal fixation with absorbable suture anchors for calcaneal apophysitis (Sever's disease). Methods The clinical data of 34 Sever's disease patients having received internal fixation with absorbable suture anchors from January 2010 to August 2012 were analyzed retrospectively. Of the 34 patients, 28 were male and 6 were female, aged from 11 to 30 years old (mean 19 years old); 20 with unilateral lesions, 14 with bilateral lesions; 32 suffered inflammatory edema, and 2 with epiphyseal avulsion. All of the patients were diagnosed as suffering from Sever's disease by X-ray combined with clinical symptoms. The sclerotic bone was chiseled off, the attachment site of Achilles tendon was fixed with auxiliary sutures of anchors and then fixed to the bone surface. Different rehabilitation programs were adapted in different periods after operation. The operation time, the site of anchorage and perioperative complications were analyzed, and the therapeutic effects were evaluated by Arner-Lindholm standard. Results All patients were followed up for 2-24 months (mean 9 months). The average operation time for one side was 40.5 minutes. No iatrogenic injury to nerve, vascular or tendon occurred during surgical procedure. No wound infection or foreign-body reaction was found after operation. The therapeutic effects evaluated by Arner-Lindholm standard were excellent in 29 cases, good in 4 and bad in 1 case. Conclusion Absorbable suture anchoring fixation is a reasonable and effective method for the treatment of Sever's disease, and it allows early exercise training for recovery of ankle function. The postoperative functional recovery is found to be satisfactory.