BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

Objective:This study aims to investigate the relationship between plague epidemics and environmental factors in Lincang City.Methods:Epidemiological survey data and environmental factors (including altitude, temperature, rainfall, and season) from plague occurrence sites in Lincang City from 1990 to 2020 were collected from Lincang Center for Disease Control and Prevention and the data sharing platform of the data sharing service network of the China Meteorological Administration, and analyzed using multiple correspondence analysis (MCA).Results:From 1990 to 2005, a total of 38 outbreaks of plague among rodents had been reported, 17 of which involved human beings. Since 2006, the plague had entered a dormant period, with no further epidemics reported up to 2020. The plague epidemic in Lincang City exhibited a clear seasonal variation, with the primary epidemic season occurred from autumn to early winter, peaking in September and October. Furthermore, the plague epidemic in Lincang City exhibited a pronounced spatial aggregation, with the primary affected regions including Linxiang County, Gengma Dai and Va Autonomous County, Zhenkang County, and Yun County. MCA showed that the Cronbach' α coefficients of all variables in the first and second dimensions were 0.87 and 0.82, respectively, and the characteristic roots were 3.27 and 2.91, respectively. The cumulative contribution rate of the two dimensions was 84.60%. Plague outbreaks were more likely in winter in areas at altitudes of > 1 400 - 1 650 m with 1 000 - 1 200 mm average annual rainfall and 16.0 - 17.9 ℃ average annual temperature, with increased severity. Regions at altitudes of > 500 - 700 m and > 900 - 1 150 m, with average annual rainfall of < 1 000, 1 201 - 1 400 and > 1 600 mm and average annual temperature of 18.0 - 19.9 ℃, showed a higher susceptibility to plague outbreaks, with notably pronounced incidences.Conclusions:The prevalence of plague epidemics is closely related to the local climatic conditions of natural foci in Lincang City. Therefore, it is imperative to enhance the monitoring of these climatic conditions, particularly meteorological data, to facilitate more effective prevention and control of plague outbreaks.

Objective:To investigate the clinical characteristics of patients with hepatitis B virus（HBV）-related primary hepatocellular carcinoma（HCC）who were treated in a multidisciplinary team（MDT）for liver cancer，so as to provide a basis for clinical optimization of the diagnosis and treatment of patients with chronic hepatitis B（CHB）.Methods:A retrospective analysis was performed for 482 HBV-related HCC patients who were treated with HCC-MDT every Thursday afternoon in The First Affiliated Hospital of the Army Medical University from January 2022 to May 2024，aged 18-87（55.54±10.84）years，86.93%（419/482）males and 13.07%（63/482）females. According to the different underlying liver diseases at the time of initial medical treatment and the different prognostic outcomes at the later follow-up，the differences in clinical characteristics between groups under different conditions were compared and analyzed，and the influencing factors of HCC prognosis were understood by Logistic regression analysis. Results:At the time of MDT presentation，the differences in HBeAg status（ χ2=6.311 ，P=0.043），γ-glutamyl traspeptidase（GGT）（ Z=6.277， P=0.043），alkaline phosphatase（ALP）（ Z=7.236 ，P=0.027），and model for end-stage liver disease（MELD）scores（ Z=6.111， P=0.047）among patients with different underlying liver diseases were statistically significant. At follow-up，6.75%（11/163）of HBV-related HCC patients who presented to MDT had a family history of HCC，and their cumulative mortality rate was as high as 60.8%（205/337）at least for 1 year. Mulitivariate Logistic regression analysis showed that different underlying liver disease at the time of initial medical treatment，HBV DNA replication level，MELD score and choice of anti-cancer treatment regimen were the influencing factors for the prognosis of HCC（all P<0.05）. The worse the degree of cirrhosis at the initial presentation，the higher the level of HBV DNA replication，and the higher the MELD score，the worse the prognosis for HCC. Conclusion:Advancing the diagnosis and treatment of CHB，maximizing the inhibition of HBV DNA replication，reducing the MELD score，and optimizing the anti-cancer treatment regimen can reduce the mortality rate of HBV-related HCC.

Objective:This study aims to investigate the relationship between plague epidemics and environmental factors in Lincang City.Methods:Epidemiological survey data and environmental factors (including altitude, temperature, rainfall, and season) from plague occurrence sites in Lincang City from 1990 to 2020 were collected from Lincang Center for Disease Control and Prevention and the data sharing platform of the data sharing service network of the China Meteorological Administration, and analyzed using multiple correspondence analysis (MCA).Results:From 1990 to 2005, a total of 38 outbreaks of plague among rodents had been reported, 17 of which involved human beings. Since 2006, the plague had entered a dormant period, with no further epidemics reported up to 2020. The plague epidemic in Lincang City exhibited a clear seasonal variation, with the primary epidemic season occurred from autumn to early winter, peaking in September and October. Furthermore, the plague epidemic in Lincang City exhibited a pronounced spatial aggregation, with the primary affected regions including Linxiang County, Gengma Dai and Va Autonomous County, Zhenkang County, and Yun County. MCA showed that the Cronbach' α coefficients of all variables in the first and second dimensions were 0.87 and 0.82, respectively, and the characteristic roots were 3.27 and 2.91, respectively. The cumulative contribution rate of the two dimensions was 84.60%. Plague outbreaks were more likely in winter in areas at altitudes of > 1 400 - 1 650 m with 1 000 - 1 200 mm average annual rainfall and 16.0 - 17.9 ℃ average annual temperature, with increased severity. Regions at altitudes of > 500 - 700 m and > 900 - 1 150 m, with average annual rainfall of < 1 000, 1 201 - 1 400 and > 1 600 mm and average annual temperature of 18.0 - 19.9 ℃, showed a higher susceptibility to plague outbreaks, with notably pronounced incidences.Conclusions:The prevalence of plague epidemics is closely related to the local climatic conditions of natural foci in Lincang City. Therefore, it is imperative to enhance the monitoring of these climatic conditions, particularly meteorological data, to facilitate more effective prevention and control of plague outbreaks.

Objective:To investigate the clinical characteristics of patients with hepatitis B virus（HBV）-related primary hepatocellular carcinoma（HCC）who were treated in a multidisciplinary team（MDT）for liver cancer，so as to provide a basis for clinical optimization of the diagnosis and treatment of patients with chronic hepatitis B（CHB）.Methods:A retrospective analysis was performed for 482 HBV-related HCC patients who were treated with HCC-MDT every Thursday afternoon in The First Affiliated Hospital of the Army Medical University from January 2022 to May 2024，aged 18-87（55.54±10.84）years，86.93%（419/482）males and 13.07%（63/482）females. According to the different underlying liver diseases at the time of initial medical treatment and the different prognostic outcomes at the later follow-up，the differences in clinical characteristics between groups under different conditions were compared and analyzed，and the influencing factors of HCC prognosis were understood by Logistic regression analysis. Results:At the time of MDT presentation，the differences in HBeAg status（ χ2=6.311 ，P=0.043），γ-glutamyl traspeptidase（GGT）（ Z=6.277， P=0.043），alkaline phosphatase（ALP）（ Z=7.236 ，P=0.027），and model for end-stage liver disease（MELD）scores（ Z=6.111， P=0.047）among patients with different underlying liver diseases were statistically significant. At follow-up，6.75%（11/163）of HBV-related HCC patients who presented to MDT had a family history of HCC，and their cumulative mortality rate was as high as 60.8%（205/337）at least for 1 year. Mulitivariate Logistic regression analysis showed that different underlying liver disease at the time of initial medical treatment，HBV DNA replication level，MELD score and choice of anti-cancer treatment regimen were the influencing factors for the prognosis of HCC（all P<0.05）. The worse the degree of cirrhosis at the initial presentation，the higher the level of HBV DNA replication，and the higher the MELD score，the worse the prognosis for HCC. Conclusion:Advancing the diagnosis and treatment of CHB，maximizing the inhibition of HBV DNA replication，reducing the MELD score，and optimizing the anti-cancer treatment regimen can reduce the mortality rate of HBV-related HCC.

Objective:To analyze the epidemiological characteristics of Japanese encephalitis (JE) in Yunnan province, China from 2000 to 2023, and to provide scientific basis for prevention and control work.Methods:Descriptive epidemiological method were used for epidemiological feature analysis. Excel 2019 and ArcGIS 10.8.2 software were used to establish case databases and map drawings, Joinpoint 4.9.1 software was used to conduct time trend analysis, and ArcGIS 10.8.2 software was used to construct a geographic information database and conduct spatial autocorrelation analysis. SaTScan 10.1.2 software was used for spatiotemporal scanning analysis.Results:A total of 7 006 JE cases and 342 deaths were reported in Yunnan province from 2000 to 2023, with an average annual incidence of 0.58/100 000 (0.03/100 000-1.69/100 000) and a fatality rate of 4.88%, both of which showed a decreasing trend. JE cases have been reported in 129 counties in 16 prefectures of the province, and the average annual incidence rate in prefecture was 0.09/100 000-1.96/100 000. Xishuangbanna, Dehong, Zhaotong, Baoshan, Pu′er, Wenshan and Chuxiong prefectures were highly prevalent areas. Spatial-temporal scanning analysis found that 33 counties in 6 prefectures in the China-Myanmar and China-Laos border areas in southwest Yunnan constitute the first-class cluster area, and 9 counties in Zhaotong prefecture in northeastern Yunnan constitute the second-class cluster area. JE cases occured in every month of the year, with the main epidemic period from May to October. The ratio of male to female cases was 1.54∶1, the proportion of the age group <15 years was 68.49%, and the age group ≥15 years was 31.51%. The proportion of scattered children and preschool children was 38.54%, with students accounting for 33.19% and farmers accounting for 21.18%.Conclusions:JE was widely distributed in Yunnan province, with high-incidence areas mainly concentrated in southwestern and northeastern Yunnan. The incidence rate among children was high, and the number of cases among adults and farmers has increased significantly. It is still necessary to strengthen the prevention and control of JE in high-risk areas, especially in rural areas, and fully implement the children′s JE immunization program and adult JE prevention measures.

Objective:To analyze the epidemiological characteristics of Japanese encephalitis (JE) in Yunnan province, China from 2000 to 2023, and to provide scientific basis for prevention and control work.Methods:Descriptive epidemiological method were used for epidemiological feature analysis. Excel 2019 and ArcGIS 10.8.2 software were used to establish case databases and map drawings, Joinpoint 4.9.1 software was used to conduct time trend analysis, and ArcGIS 10.8.2 software was used to construct a geographic information database and conduct spatial autocorrelation analysis. SaTScan 10.1.2 software was used for spatiotemporal scanning analysis.Results:A total of 7 006 JE cases and 342 deaths were reported in Yunnan province from 2000 to 2023, with an average annual incidence of 0.58/100 000 (0.03/100 000-1.69/100 000) and a fatality rate of 4.88%, both of which showed a decreasing trend. JE cases have been reported in 129 counties in 16 prefectures of the province, and the average annual incidence rate in prefecture was 0.09/100 000-1.96/100 000. Xishuangbanna, Dehong, Zhaotong, Baoshan, Pu′er, Wenshan and Chuxiong prefectures were highly prevalent areas. Spatial-temporal scanning analysis found that 33 counties in 6 prefectures in the China-Myanmar and China-Laos border areas in southwest Yunnan constitute the first-class cluster area, and 9 counties in Zhaotong prefecture in northeastern Yunnan constitute the second-class cluster area. JE cases occured in every month of the year, with the main epidemic period from May to October. The ratio of male to female cases was 1.54∶1, the proportion of the age group <15 years was 68.49%, and the age group ≥15 years was 31.51%. The proportion of scattered children and preschool children was 38.54%, with students accounting for 33.19% and farmers accounting for 21.18%.Conclusions:JE was widely distributed in Yunnan province, with high-incidence areas mainly concentrated in southwestern and northeastern Yunnan. The incidence rate among children was high, and the number of cases among adults and farmers has increased significantly. It is still necessary to strengthen the prevention and control of JE in high-risk areas, especially in rural areas, and fully implement the children′s JE immunization program and adult JE prevention measures.

Objective To summarize the experience of cannulation for extracorporeal membrane oxygenation (ECMO) in infants less than 5 kg. Methods Eleven infants with ECMO support who weighed less than 5 kg were admitted to critical care medicine of Guangzhou Women and Children's Medical Center from June 2016 to June 2018 were enrolled. Retrospective analysis of support type, configuration, site of cannula and complication of ECMO was performed. Results The 11 infants consisted of 9 males and 2 females. The weight on ECMO of 1.96-4.60 kg, with an average of (3.14±0.65) kg; age 0.1-30.0 days, with a median of 5.6 (1.5, 8.3) days. Four cases were given ECMO because of congenital diaphragmatic hernia with severe pulmonary hypertension and other 7 cases were cannulated due to complication of congenital cardiac surgery. All infants were received veno-arterial (V-A) ECMO. In 4 cases, the cannulas were placed in the right internal jugular vein for drainage (8-10 French catheter with 6.0-7.5 cm depth) and the right carotid artery for infusion (6-8 French catheter with 2.5-3.5 cm depth); the average time of cannulation in right carotid and jugular vessels was (73±20) minutes (range 55-100 minutes). In other 7 cases, the cannulas were inserted into the right atrium (12-14 French catheter with 2.8-3.0 cm depth) for draining blood and returning it to the ascending aorta (6-8 French catheter with 1.0-2.0 cm depth); the average time of cannulation in central vessels was (64±31) minutes (range 35-110 minutes) with exclusion of 2 cases intraoperative cannulation. There were three infants with complications. One episode was shown in vascular rupture, one in catheter site hemorrhage and one in cannula malposition with later repositioning. There was no case of insertion site infection, cannula-related bloodstream infection and accident detached cannula. Conclusion Cannulation for ECMO can be performed in infants less than 5 kg with a high rate of success and a low rate of complication owing to appropriate catheter and skillful cannulation.

Objective: To establish the culture technique for culturing γδ T cells in vitro and evaluate the basic characteristics, security and anti-tumor effect of the cultured γδ T cells. Methods: Phytohemagglutinin, zoledronic acid, interleukin-2 and interleukin -7 were used to induce the abundant expansion of peripheral blood mononuclear cells in vitro. Flow cytometry assay, in vitro killing assay and mouse model of human lung cancer were also adopted to assess the characteristics and the anti-tumor effect of cultured γδ T cells. Additionally, the contamination of exogenous agents and the acute toxicity of γδ T cells were determined. Results: After culturing 14-16 days in vitro, the total number of γδ T cells was more than 1.0×10¹⁰. Among these γδ T cells, CD3⁺ γδ TCR⁺ cells accounted for more than 90%. None of contaminations of bacteria, fungi, mycoplasma and virus were observed. At effect target ratio (E/T ratio) of 50/1, killing efficiency of γδ T cells cultured in vitro to SK-MES-1, Ho8910, A549 and K562 reached more than 65%. In vivo experiments showed that the tumor volume of γδ T-treated mice was (828.99±61.05) mm^3, significantly lower than (1 723.51±84.30) mm³ of the control mice (P<0.05). Meanwhile, no acute toxicity effect was observed in γδ T cells treated mice. Conclusion The number, purity and activity of γδT cells cultured in our institute can reach the requirement of clinical application, and the γδT cells also display strong cytotoxic activity against tumor cells such as lung cancer, ovarian cancer and leukemia.

Objective To compare the clinical efficacy of anteroposterior approach (APA) versus anterior approach (AA) for decompression,fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex (PLC).Methods From February 2006 to June 2012,55 patients were treated for single-level unstable thoracolumbar vertebrae fractures.Of them,27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position.The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale (VAS),overall score of short-form health survey (SF-36),Japanese Orthopaedics Association (JOA) score of lower back,Oswestry disability index (ODI),loss ratio of anterior margin of vertebral height,endplate angle of kyphotic deformity of superior-inferior adjacent vertebrae,wedge angle of fractured vertebra via radiographic measurement and canal compromise rate.The neurologic functional recovery was analyzed using the American Spine Injury Association (ASIA) evaluation system at postoperative 12 months.Results There were no significant differcnces in operative time,amount of blood loss or postoperative drainage between the 2 groups (P ＞ 0.05).At postoperative 3 months,the VAS and JOA scores in the APA group were significantly better than those in the AA group (P ＜ 0.05).At 12 months after surgery,the VAS,kyphotic angle of adjacent vertebra,wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group (P ＜ 0.05).There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months (P ＞ 0.05).All the comparative indexes were significantly improved than the preoperative values in all the patients in the 2 groups at both 3 and 12 months (P ＜ 0.05).Conclusions Compared with the merely anterior approach,the combined antero-posterior approach may have advantages of better immediate and persistent reduction,steadily rebuilding fractured alignment,continuously maintaining injured biomechanical stability,and obviously improving neurological function.As the antero-posterior approach allows for combination of posterior auxiliary reduction and fixation with anterior definitive support and decompression,it may lead to a safe and effective treatment of unstable single-level thoracolumbar fracture concomitant with incomplete neurologic and PLC impairments.