Objective:To explore a new surgical approach [anteromedial approach of the hip (AMA)] for Pipkin Ⅰ and Ⅱ femoral head fractures through an imaging and anatomical study.Methods:The hip imaging data were collected of the 38 patients who had undergone lower limb CT angiography for open tibiofibular fractures at Department of Orthopaedics, The Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University from June 2023 to January 2024. There were 20 males aged (40.9±3.5) years and 18 females aged (41.5±3.3) years. The origins and shapes of the femoral artery and its main branches were observed. The distances between the femoral head and the femoral artery, the medial femoral circumflex artery, and the lateral femoral circumflex artery were measured. Four fresh adult cadavers were collected, including 2 males and 2 females. Their ages of death were 56, 65, 72 and 78 years old, respectively. An incision was made along the axis of the limb at the midpoint of the inguinal ligament at the 4 fresh cadavers. After the femoral head was exposed through the gap between the femoral artery and the femoral nerve, the range of the femoral head exposed was marked.Results:The femoral artery ran along the anteromedial side of the femoral head. The shortest distance between the medial femoral circumflex artery and the femoral head was (13.1±5.7) mm, and the shortest distance between the origin of the lateral femoral circumflex artery and the femoral head (21.6±8.6) mm. On the lateral view of CT angiography, the distance between the femoral artery and the femoral head was (20.6±4.9) mm at the level of the apex of greater trochanter. Gross observation on the cadavers found only small branches of vessels between the femoral artery and the femoral nerve. After the femoral artery and femoral nerve were respectively pulled medially and laterally, the anterior-inferior part of the femoral head was exposed directly by pulling the muscles to open the joint capsule. The exposure range of the femoral head was further expanded through internal and external rotation of the hip joint under traction. The anatomical gap between the femoral artery and the femoral nerve was named the AMA.Conclusion:AMA utilizes the potential gap between the femoral artery and the femoral nerve, providing a new surgical approach for exposure and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures.

Objective:To explore a new surgical approach [anteromedial approach of the hip (AMA)] for Pipkin Ⅰ and Ⅱ femoral head fractures through an imaging and anatomical study.Methods:The hip imaging data were collected of the 38 patients who had undergone lower limb CT angiography for open tibiofibular fractures at Department of Orthopaedics, The Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University from June 2023 to January 2024. There were 20 males aged (40.9±3.5) years and 18 females aged (41.5±3.3) years. The origins and shapes of the femoral artery and its main branches were observed. The distances between the femoral head and the femoral artery, the medial femoral circumflex artery, and the lateral femoral circumflex artery were measured. Four fresh adult cadavers were collected, including 2 males and 2 females. Their ages of death were 56, 65, 72 and 78 years old, respectively. An incision was made along the axis of the limb at the midpoint of the inguinal ligament at the 4 fresh cadavers. After the femoral head was exposed through the gap between the femoral artery and the femoral nerve, the range of the femoral head exposed was marked.Results:The femoral artery ran along the anteromedial side of the femoral head. The shortest distance between the medial femoral circumflex artery and the femoral head was (13.1±5.7) mm, and the shortest distance between the origin of the lateral femoral circumflex artery and the femoral head (21.6±8.6) mm. On the lateral view of CT angiography, the distance between the femoral artery and the femoral head was (20.6±4.9) mm at the level of the apex of greater trochanter. Gross observation on the cadavers found only small branches of vessels between the femoral artery and the femoral nerve. After the femoral artery and femoral nerve were respectively pulled medially and laterally, the anterior-inferior part of the femoral head was exposed directly by pulling the muscles to open the joint capsule. The exposure range of the femoral head was further expanded through internal and external rotation of the hip joint under traction. The anatomical gap between the femoral artery and the femoral nerve was named the AMA.Conclusion:AMA utilizes the potential gap between the femoral artery and the femoral nerve, providing a new surgical approach for exposure and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures.

Liver depression and spleen deficiency syndrome is a common syndrome type of ulcerative colitis (UC). Based on the theory of 'collaborative treatment of liver and spleen', TCM shows its effect and less adverse reactions in the treatment of UC with liver depression and spleen deficiency. The internal treatment of TCM based on syndrome differentiation and treatment by stages, as well as the external treatment of TCM based on TCM enema therapy, acupuncture therapy and acupoint application therapy, can relieve symptoms, improve relevant clinical indicators and improve the quality of life of patients. The mechanism studies show that the TCM with the effect of soothing the liver and activating the spleen plays a therapeutic role by regulating signal pathway conduction, regulating intestinal flora, and improving the level of inflammatory factors.

Objective:To investigate the value of fetal heart quantification (fetal HQ) in assessing ventricular function of fetuses with small-for-gestational-age (SGA) and fetal growth restriction (FGR).Methods:A total of 152 singleton pregnancies with estimated fetal weight (EFW) or abdominal circumference less than the 10th percentile in the Third Affiliated Hospital of Zhengzhou University were prospectively selected from August 2022 to September 2023, where fetal EFW or abdominal circumference were in the 3rd to 9th percentile with normal Doppler findings were classified as the SGA group ( n=79), and the rest as the FGR group ( n=73). In the same period, 161 cases of normal single fetuses were matched as the control group.Based on the gestational week in which FGR occurred, the FGR group were categorized into the early-onset group (<32 weeks, n=46) and the late-onset group (≥32 weeks, n=27), and fetuses in the FGR group with absent end-diastolic velocity of the umbilical artery were defined as severe FGR ( n=11), and the rest as mild FGR ( n=62). Fetal ventricular fractional area change (FAC), global longitudinal strain (GLS), longitudinal fractional shortening (LFS) and 24-segment fractional shortening (FS) were obtained by fetal HQ. The cardiac systolic function between groups were compared, the correlations between each parameter and gestational week were analyzed, the inter-observer and intra-observer repeatability tests were performed. Results:Compared with the control group, ventricular FAC, LFS, and GLS were lower in the SGA and the FGR group, right ventricular FS of segments 9-24 were reduced in the SGA group, and left ventricular FS of segments 10-19, 21-24 and right ventricular FS of segments 18-24 were reduced in the FGR group, the differences were statistically significant (all P<0.05). Left ventricular GLS, LFS and right ventricular FAC, GLS, LFS, FS of segments 1-14 were lower in the severe FGR group than in the mild FGR group, the differences were statistically significant (all P<0.05). The values of left ventricular GLS and LFS were higher in the early-onset FGR group than in the late-onset FGR group, the differences were statistically significant (all P<0.05). The ROC showed that the ventricular systolic function parameters predicted adverse perinatal outcomes with an AUC>0.6 (all P<0.05). Left ventricular GLS and right ventricular partial-segments FS were no correlations with gestational week in the FGR group (-0.3< rs<0.3, all P<0.05). There was no correlation between the parameters and gestational week in the SGA group (all P>0.05). The inter-observer and intra-observer intraclass correlation coefficients (ICC) were >0.75, with good reproducibility. Conclusions:Fetal HQ can quantitatively assess the changes of ventricular function in SGA and FGR fetuses, and the ventricular overall, longitudinal and localized contractile function in SGA and FGR fetuses are reduced, and abnormal ventricular systolic function is associated with adverse perinatal outcomes.

Objective To investigate the effects and potential mechanisms of ultrasound-guided thoracic paravertebral block (TPVB) combined with general anesthesia in patients undergoing thoracoscopic surgery. Methods A total of 122 patients undergoing thoracoscopic surgery were selected and randomly divided into control group and tudy group, with 61 patients in each group.The control group received general anesthesia, while the study group received ultrasound-guided TPVB combined with general anesthesia.Clinical data and perioperative indicators were recorded and compared between the two groups.Mean arterial pressure (MAP), heart rate (HR), Visual Analogue Scale (VAS) scores before surgery, 24 hours and 72 hours after surgery, and inflammatory factors[interleukin-6(IL-6), interleukin-10(IL-10), tumor necrosis factor-α(TNF-α)], oxidative stress indicators[malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)]levels before surgery and 72 hours after surgery were compared between the two groups.Postoperative adverse reactions were recorded.Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of key molecules mRNA in the Nrf2/Keap1/ARE pathway in the peripheral blood of patients in the two groups. Results There were no statistically significant differences in operative time and intraoperative blood loss between the two groups (P>0.05).The study group had shorter extubation time and indwelling time of drainage tube, less total drainage volume, and less total PCIA drug consumption within 36 hours after surgery and times of patient controlled intravenous analgesia (PCIA) effective compression compared to the control group (P < 0.05).At 24 and 72 hours after surgery, MAP, HR, and VAS scores were higher than preoperative levels in the control group, while VAS scores were higher than preoperative levels in the study group, but MAP, HR, and VAS scores were lower in the study group compared to the control group (P < 0.05).At 72 hours after surgery, serum levels of IL-6, IL-10, TNF-α, and MDA were higher than preoperative levels, while SOD and GSH-Px levels were lower than preoperative levels in both groups.Additionally, the study group had lower serum levels of IL-6, TNF-α, and MDA and higher levels of IL-10, SOD, and GSH-Px compared to the control group (P < 0.05).The total incidence of postoperative adverse reactions was 4.92%(3/61) in the study group, which was lower than 21.31%(13/61) in the control group (P < 0.05).At 72 hours after surgery, the expression levels of Nrf2 mRNA and ARE mRNA in the peripheral blood of patients in the study group were lower than those in the control group, while the expression level of Keap1 mRNA was higher (P < 0.05). Conclusion Compared with general anesthesia, ultrasound-guided TPVB combined with general anesthesia can significantly improve hemodynamic stability and analgesic effects in patients with early-stage lung cancer after thoracoscopic surgery, relieve inflammatory and oxidative stress responses, and decrease the incidence of postoperative adverse reactions.The molecular mechanism may be related to the inhibition of Nrf2/Keap1/ARE signaling pathway activation.

Through systematic review of literature, Delphi expert consultation and expert discussion meeting, the Nursing expert consensus on application of cardiopulmonary resuscitation machine in treating patients with in- hospital cardiac arrest was formulated. Finally, 8 parts of the application specifications including evaluation before boarding, cooperation during boarding, detection and management after boarding, cooperation during weaning, quality control and training, and fault handling were formed, in order to provide guidance and reference for the application of cardiopulmonary resuscitation machine in treating patients with in-hospital cardiac arrest.

Congenital infiltrating lipomatosis of the face is a rare disorder resulting from overgrowth of adipose tissues. This condition presents gradually with swelling along with age, hypertrophy of adjacent bones, and tooth abnormalities. This study reports a case of congenital infiltrating lipomatosis of face with seizures and reviews relevant literature on the etiology, clinical symptom, diagnosis, and treatment of this condition.
Adipose Tissue ; Face ; Humans ; Lipomatosis ; complications ; Seizures ; complications

The 'Conclusion' section in the Abstract was published incorrectly in the original publication of the article [1] and is corrected with this erratum as below: "Fetal exposure to the Chinese famine may be associated with an increased risk of hypertension in adulthood in women."

Objective To learn the diagnosis and treatment of brucellosis patients in Suide County of Shaanxi Province in 2015,and to provide a scientific basis for making accurate prevention and control measures.Methods All the cases diagnosed as brucellosis in Suide County from January 1 to December 31 in 2015 and lived in this county were retrospectively investigated by case questionnaire survey,including basic information,medical procedures,and epidemiological contacts.Descriptive statistical analysis was performed using SPSS 18.0 software.Results In 2015,75 cases of brucellosis were diagnosed in Suide County,75 questionnaires were distributed,with 53 completed questionnaires returned.The average age of respondents was (49 ± 14) years old,of which 84.9％ (45/53) were male and 94.3％ (50/53) were farmers,except one case was actively monitored by Suide County Centre for Disease Control and Prevention then treated,the rest of the patients were treated after the onset of the disease.Of the 52 patients,one patient was diagnosed after one visit,accounting for 25.0％ (13/52);one patient was diagnosed after at least 4 visits,accounting for 3.8％ (2/52).The cumulative diagnosis rate at provincial-level hospitals was 1/3 and that at disease prevention and control institutions was 92.7％ (51/55),there were no confirmed cases in municipal hospitals,county hospitals,township hospitals,village clinics and individual clinics.For the first reason to see a doctor,65.4％ (34/52) of the patients were fever or accompanied by sweating,fatigue,arthralgia and waist and leg pain.The medians from onset to treatment between the first diagnosis,and 2,3,4 visits were 15,18,27,45 days,respectively;the median from onset to diagnosis was 21 days,ranging from 2 to 182 days.Totally 84.9％ (45/53) patients had a history of exposure to animals,of which 97.8％ (44/45) had contacted the sheep.Conclusions The cases in Suide County are mainly adult male farmers,and the diagnosis rate at hospitals below municipal level is low.It is recommended to strengthen the health intervention of high-risk groups and improve the level of diagnosis and treatment of primary medical staff.