OBJECTIVE: To explore the effectiveness of the modified Lemaire procedure in anterior cruciate ligament reconstruction (ACLR) in patients with a highly positive pivot shift test. METHODS: The clinical data of 18 patients with anterior cruciate ligament (ACL) rupture and highly positive pivot shift test between April 2020 and September 2022 were retrospectively analyzed. There were 13 males and 5 females with an average age of 28.3 years (range, 17-41 years). Causes of injury included 11 cases of direct violence injury, including 6 cases of traffic accident injury, 4 cases of sports injury, 1 case of falling injury; 7 cases of indirect violence injury, all sports injury. All patients had complete ACL rupture, including 15 acute injuries and 3 old injuries. The preoperative pivot shift test was grade Ⅱ in 9 cases and grade Ⅲ in 9 cases. All patients were treated with ACLR combined with modified Lemaire procedure. The International Knee Documentation Committee (IKDC) score and Lysholm score were used to evaluate the effectiveness before operation and at 3, 6, 12 months after operation. KT-2000 arthrometer was used to measure the anterior stability of the knee joint, and the difference between the healthy and affected sides was recorded. Pivot shift test was used to evaluate the rotational stability of the knee joint. During the follow-up, X-ray films were taken to observe the bone tunnel and internal fixation, and MRI was used to examine the healing of ACL, anterolateral collateral ligament and fibular collateral ligament grafts. RESULTS: All patients completed the operation successfully without complications such as knee joint infection, vascular and nerve injury. All patients were followed up 12-19 months (mean, 13.2 months). After operation, the rotational stability of the knee joint recovered satisfactorily, and there was no adverse symptom such as knee instability and locking at last follow-up. X-ray film and MRI showed that the bone tunnel was anatomically located and healed well, the internal fixation was in good position, and the reconstructed ACL and iliotibial band were continuous and in good tension. The IKDC score, Lysholm score, and the difference of KT-2000 between the healthy and the affected sides significantly improved at 3, 6, and 12 months after operation ( P<0.05). All the indicators further improved with time after operation, except that there was no significant difference in IKDC score between 3 and 6 months after operation and in the difference of KT-2000 between 3 months and 6, 12 months after operation ( P>0.05), and there were significant differences in other indicators between different time points ( P<0.05). Pivot shift test was negative immediately after operation and at last follow-up. CONCLUSION In ACL injuries with a highly positive pivot shift test, ACLR combined with the modified Lemaire procedure can effectively restore anterolateral knee stability, leading to satisfactory knee stability and function in the early postoperative period.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Male ; Female ; Anterior Cruciate Ligament Injuries/physiopathology* ; Adult ; Adolescent ; Retrospective Studies ; Young Adult ; Anterior Cruciate Ligament/surgery* ; Treatment Outcome ; Joint Instability/surgery* ; Knee Joint/physiopathology* ; Range of Motion, Articular

Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.

Objective:To compare the clinical efficacy of TINAVI orthopaedic robot-assisted pedicle screw placement and free-hand pedicle screw placement in the treatment of lumbar spondylolysis in adolescents.Methods:The clinical data of 65 adolescents with lumbar spondylolysis who underwent surgery in Honghui Hospital, Xi′an Jiaotong University from January 2021 to December 2022 were analyzed retrospectively, including 20 males and 45 females with an age of (21.5 ± 4.3) years. The distribution of spondylolysis included 2 cases of L 3, 13 cases of L 4, 50 cases of L 5. According to the Meyerding classification of spondylolisthesis degree, there were 52 cases of grade Ⅰ, 5 cases of grade Ⅱ and 8 cases without spondylolisthesis, all of which were complicated with intractable back pain. All patients were treated with double segmental pedicle screw reduction and autogenous iliac bone graft. According to different screw placement methods, they were divided into TINAVI orthopedic robot-assisted screw placement group (robot group, 32 cases) and free-hand screw placement group (free-hand group, 33 cases). CT was re-examined after operation. The satisfactory rate of pedicle screw placement and cortical penetration rate were calculated according to Neo standard, and the superior articular process invasion rate of screw was calculated by Babu standard. The operation time, intra-operative blood loss, post-operative drainage, hospital stay, satisfactory rate of screw placement, cortical puncture rate and superior articular process invasion rate were compared between the two groups, and the operative complications and bony fusion time of isthmus were recorded. The visual analogue score (VAS) of lumbar pain, the score of Japanese Orthopaedic Association (JOA) and the score of Oswestry dysfunction (ODI) were compared between the two groups before operation, 1 month after operation and 1 year after operation. Results:There was no significant difference in preoperative general data between the two groups ( P>0.05). All patients completed the operation successfully, anatomical reduction was achieved in patients with spondylolisthesis. No serious operative complications such as nerve and vascular injury occurred during surgery. The operation time in the robot group was longer than that in the free-hand group: (82.6 ± 6.8) min vs. (60.5 ± 7.1) min. There was no significant difference in intra-operative blood loss, post-operative drainage and hospital stay between the two groups ( P>0.05). A total of 128 screws were placed in the robot group, and 132 screws were placed in the freehand group. There were significant differences in the satisfaction rate of screw insertion, cortical penetration rate and articular process invasion rate between the two groups: 96.9%(124/128) vs. 90.9%(120/132), 3.1%(4/128) vs. 9.1%(12/132), 2.3%(3/128) vs. 7.6%(10/132) ( P<0.05). One year after surgery, the isthmus of all patients fused well, the reduction was not lost, the intervertebral disc had no degeneration, and the instrumentation was removed. The VAS, JOA score and ODI score of the two groups at 1 month and 1 year after operation were significantly better than those before operation ( P<0.05). The VAS of the robot group was lower than that of the free-hand group at 1 month and 1 year after operation: (1.6 ± 0.8) points vs. (2.7 ± 0.9) points, (0.3 ± 0.1) points vs. (1.5 ± 0.2) points, the difference is statistically significant ( P<0.05). However, there was no significant difference in JOA score and ODI score between the two groups ( P>0.05). Conclusions:TINAVI orthopaedic robot assisted screw placement and free-hand screw placement can both effectively treat lumbar spondylolysis in adolescents. Compared with free-hand screw placement, TINAVI orthopedic robot assisted screw placement can further improve the accuracy and improve patients′ lumbodorsal pain.

Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

Sonodynamic therapy (SDT) can potentially induce immunogenic cell death in tumor cells, leading to the release of ATP, and facilitating the initiation of an immune response. Nevertheless, the enzymes CD39 and CD73 can swiftly convert ATP into immunosuppressive adenosine (ADO), resulting in an immunosuppressive tumor microenvironment (TME). This study introduced a nanomedicine (QD/POM1@NP@M) engineered to reprogram TME by modulating the CD39/CD73/ADO pathway. The nanomedicine encapsulated sonosensitizers silver sulfide quantum dots, and the CD39 inhibitor POM1, while also incorporating homologous tumor cell membranes to enhance targeting capabilities. This integrated approach, on the one hand, stimulates the release of ATP via SDT, thereby initiating the immune response. In addition, it reduced the accumulation of ADO by inhibiting CD39 activity, which ameliorated the immunosuppressive TME. Upon administration, the nanomedicine demonstrated substantial anti-tumor efficacy by facilitating the infiltration of anti-tumor immune cells, while reducing the immunosuppressive cells. This modulation effectively transformed the TME from an immunologically "cold" state to a "hot" state. Furthermore, combined with the checkpoint inhibitor α-PDL1, the nanomedicine augmented systemic anti-tumor immunity and promoted the establishment of long-term immune memory. This study provides an innovative strategy for combining non-invasive SDT and ATP-driven immunotherapy, offering new ideas for future cancer treatment.

In recent years, the spread of clubroot disease caused by Plasmodiophora brassicae infection has seriously affected the yield and quality of Brassica juncea (L.) Czern.. The cascade of mitogen-activated protein kinases (MAPKs), a highly conserved signaling pathway, plays an important role in plant responses to both biotic and abiotic stress conditions. To mine the MAPK genes related to clubroot disease resistance in B. juncea, we conducted a genome-wide analysis on this vegetable, and we analyzed the phylogenetic evolution and gene structure of the MAPK gene family in mustard. The 66 BjuMAPK genes identified by screening the whole genome sequence of B. juncea were unevenly distributed on 17 chromosomes. At the genomic scale, tandem repeats led to an increase in the number of MAPK genes in B. juncea. It was found that members of the same subfamily had similar gene structures, and there were great differences among different subfamilies. These predicted cis-acting elements were related to plant hormones, stress resistance, and plant growth and development. The expression of BjuMAPK02, BjuMAPK15, BjuMAPK17, and BjuMAPK19 were down-regulated or up-regulated in response to P. brassicae infection. The above results lay a theoretical foundation for further studying the functions of BjuMAPK genes in B. juncea in response to the biotic stress caused by clubroot disease.
Mustard Plant/parasitology* ; Plasmodiophorida/pathogenicity* ; Plant Diseases/genetics* ; Mitogen-Activated Protein Kinases/metabolism* ; Phylogeny ; Disease Resistance/genetics* ; Gene Expression Regulation, Plant ; Genome, Plant ; Plant Proteins/genetics*

Anterior cruciate ligament (ACL) injury is a common disease of the knee joint, which affects the stability of the knee joint. As an emerging field, artificial intelligence (AI) has developed rapidly in the diagnosis and treatment of ACL injury in recent years, improving the accuracy and timeliness of the whole diagnosis and treatment process to improve the prognosis of ACL injury. This article reviews the research progress of AI in diagnosis of ACL injury, ACL reconstruction, prediction of postoperative outcomes, and postoperative rehabilitation. We hope this information may help surgeons to improve the success rate of AI in diagnosis and treatment of ACL injury and provide cutting-edge technical support to improve patient outcomes.

Objective To investigate whether the geometric triangular relationship between the Blumensaat line and the tibial plateau can serve as an auxiliary diagnostic index for identifying and evaluating anterior cruciate ligament(ACL)injuries,thereby enhancing diagnostic accuracy.Methods A retrospective self-controlled study was conducted involving 64 patients diagnosed with unilateral ACL injury via arthroscopy and treated with ACL reconstruction at Qingdao Municipal Hospital from January to August 2023.Ultimately,40 cases were included in the analysis.Preoperative MRI images of the affected knees and contralateral healthy knees were collected as the ACL injury group and control group,respectively.In the MRI images,point C,point D,and point E were defined as the anterior end,posterior end,and midpoint of the Blumensaat line,respectively;point A and point B were defined as the turning points of the anterior and posterior edges of the tibial plateau,respectively;and point C'was defined as the intersection of the extension line of DC and line AB.Based on these anatomical landmarks,angles ∠DAB,∠CEB,∠DC'B,and ∠CDB were established.The intra-class correlation coefficient(ICC)was calculated to assess measurement consistency and reproducibility.Differences between the aforementioned angles were compared,and the area under the receiver operating characteristic(ROC)curve was computed to evaluate diagnostic performance.Results For ∠CDB,∠DC'B,∠CEB,and ∠DAB,the intra-group and inter-group correlation coefficients all exceeded 0.80,indicating excellent consistency and reproducibility.Compared to the control group,the angles ∠CDB,∠CEB,and ∠DAB in the ACL injury group were significantly reduced(P<0.001).Among these,∠DAB appears to be the most reliable index for diagnosing and evaluating ACL injuries,with an area under the receiver operating characteristic curve(AUC)of 0.829,a cut-off value of 42.2°,a sensitivity of 82.5%,and a specificity of 80.0%.Conclusion The geometric triangular relationship between the Blumensaat line and the tibial plateau in MRI images,particularly the angle ∠DAB,can serve as an auxiliary indicator for diagnosing and evaluating ACL injuries,thereby enhancing diagnostic accuracy.

BACKGROUND:The knee osteoarthritis,a major cause of disability in the elderly,is currently treated with surgical procedures including unicompartmental knee arthroplasty in end-stage patients,but the recovery of muscle strength in patients after unicompartmental knee arthroplasty is not well understood.OBJECTIVE:To analyze the short-term and medium-term knee isometric muscle strength characteristics of patients with unilateral knee osteoarthritis after unicompartmental knee arthroplasty,to compare with those of the unaffected side,and to analyze the recovery of muscle strength in the affected limb.METHODS:Patients undergoing unicompartmental knee arthroplasty in the Qingdao Municipal Hospital from June to December 2023 were recruited to undergo standardized functional rehabilitation exercises.The A8-2M multi-joint isokinetic training and testing system was used to detect the peak torque and the maximum one-repetition work of the extensor muscle of the unaffected side and the affected side of the knee joint at the angular velocity of 60(°)/s and the range of joint motion of 0°-90° before,1 and 3 months after surgery.RESULTS AND CONCLUSION:(1)At an angular velocity of 60(°)/s,the peak moment and maximum one-repetition work of the flexor and extensor muscles of the affected side were lower than those of the unaffected side preoperatively(P＜0.05).(2)The peak moment and maximum one-repetition work of the flexor and extensor muscles were significantly lower than those of the unaffected side 1 month postoperatively(P＜0.05).Meanwhile,the peak moment of the flexor and extensor muscles and the maximum one-repetition work of the flexor and extensor muscles on the affected side at 1 month postoperatively were significantly lower than those on the affected side preoperatively(P＜0.05).(3)The peak moment of the flexor and extensor muscles and the maximum one-repetition work of the flexor and extensor muscles on the affected side at 3 months postoperatively had no significant difference from those on the unaffected side.The peak flexor-extensor moment of the flexor-extensor muscles on the affected side was higher than that preoperatively(P＜0.05).(4)It is indicated that after unicompartmental knee arthroplasty,the muscle strength on the affected side is poor after 1 month after standard functional rehabilitation.However,after 3 months,there was no significant difference between the affected side and the unaffected side.

Objective:To explore the mediating effect of self-compassion between post-traumatic stress disorder (PTSD) and posttraumatic growth (PTG) in patients with ischemic stroke (IS) .Methods:From January 2021 to March 2024, convenience sampling was used to select 165 first-episode IS patients from Xinxiang Central Hospital as research subjects. General Information Questionnaire, Self-Compassion Scale (SCS), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Post-Traumatic Growth Inventory (PTGI) were used for the survey. The mediating effect of self-compassion between PTSD and PTG was analyzed.Results:A total of 165 questionnaires were distributed and 162 were collected, with a response rate of 98.18%. The total scores of SCS, PCL-C, and PTGI in 162 patients with ischemic stroke were (74.53±10.78), (33.94±9.27), and (56.77±8.33), respectively. Mediating analysis showed that self-compassion partially mediated PTSD and PTG in patients with ischemic stroke ( P<0.01) . Conclusions:Self-compassion plays a partial mediating role in PTSD and PTG in patients with ischemic stroke. Medical and nursing staff should pay attention to improving patients' self-compassion, reducing stress disorders, and promoting PTG.