ObjectiveTo explore the correlation among knee hyperextension angle, lower limb joints kinematics parameters and the activation of main muscles of lower limb in stroke hemiplegic patients with knee hyperextension during walking. MethodsFrom August, 2020 to September, 2021, 24 stroke hemiplegic patients with knee hyperextension and 24 healthy subjects matched with sex, age, height and body mass with knee hyperextension were analyzed with three-dimensional gait analysis system and the wireless surface electromyography acquisition system, to record the range of motion of pelvis, hip, knee and ankle joints in sagittal plane, and the activation of bilateral gluteus maximus, biceps femoris, vastus medialis and gastrocnemius medialis. ResultsAs the maximum of knee hyperextension, range of motion of the joints in sagittal plane and the activation of the muscles were different between the patients and the healthy subjects during the single-support phase of walking (|t| > 3.080, P < 0.01), and the maximum of knee hyperextension correlated with the activation of gluteus maximus in the patients (r = -0.532, P < 0.01), and the range of motion of ankle plantar flexion in both the patients and the healthy subjects (r > 0.686, P < 0.001). ConclusionThe correction for knee hyperextension gait in stroke hemiplegic patients may not only need to pay attention to knee joint control, but also need further treatment of ankle control and hip muscle function.

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Objective:To compare the detection performance of serum free light chain (sFLC) in two platforms and evaluate the comparability of serum free light chain results in patients with multiple myeloma (MM).Methods:To evaluate the detection performance (repeatability, accuracy, linear range, reference range, interfering substances, etc.) of sFLC kit based on polyclonal antibodies. Spearman correlation analysis and Bland-Altman were used to analyze 214 sFLC results obtained on two detection platforms at the same time to evaluate the correlation between the results of the two methods and analyze the causes of methodological bias. 119 cases with aMM and 23 cases of disease control group (AL, WM, POEMS syndrome, MGUS, diffuse large B-cell lymphoma) initially diagnosed in the hematology department of Zhongshan Hospital of Fudan University from March 2020 to March 2021 were all included. A retrospective analysis was conducted to calculate the area under the curve of receiver operating characteristic (AUC-ROC) and obtain the optimal sensitivity and specificity cut-off points for the diagnosis of MM patients on monoclonal antibody platform.Results:Repeatability, accuracy, linear range, reference interval and anti-interfering capacity of the detection platform based on polyclonal antibodies were verified to meet clinical needs. The overall consistency of FLC/κ, FLC/λ and κ/λ ratios in two methods was 89.3%, 84.1% and 77.1% respectively; but the correlation results were highly heterogeneous. The correlation coefficient of FLC/κ R 2 was 0.922( P<0.001), while the correlation coefficients R 2of the FLC/λ and κ/λ ratios were only 0.349 and 0.441( P<0.001). After segment analysis, it was found that the correlation of FLC/λ was improved within the linear range and R 2 could rise to 0.78( P<0.001). Compared with monoclonal antibody platform, the vast majority points of FLC/κ fell within the 95% limit by Bland Altman analysis. While the results of FLC/λ on polyclonal antibody platform showed significant positive bias. The AUC of MM diagnosis on monoclonal antibody platform was 0.751 ( P=0.001), and the optimal cutoff value was 24.67. Conclusion:The overall consistency between the two platforms was good, but there were significant differences between the results, so they were not comparable and could not be interchanged. For monitoring the prognosis of patients with multiple myeloma, the same platform should be selected for testing.

Objective:To investigate the teaching effect of flipped classroom combined with problem-based learning (PBL) in the teaching of the Diagnostic Audiology course.Methods:A total of 72 undergraduate students majoring in audiology and speech rehabilitation in the classes of 2019 and 2020 in Chongqing Medical University were enrolled as subjects, and three chapters of the Diagnostic Audiology course were selected for teaching reform. The 34 students in the class of 2019 were enrolled as control group and received lecture-based learning (LBL), and the 38 students in the class of 2020 were enrolled as experimental group and received flipped classroom combined with PBL. The teaching effect was evaluated by comparing the two groups in terms of classroom test scores, classroom participation scores, degree of satisfaction with teaching effect, and overall satisfaction with teaching. SPSS 23.0 software was used to perform the t-test, the chi-square test, and the Mann-Whitney U test. Results:The experimental group had a significantly higher classroom test score than the control group (25.95±1.21 vs. 23.21±1.55, P<0.001). In terms of classroom participation scores, the experimental group had significantly higher scores of participation in class discussion, cooperative and collaborative abilities, and questioning skills than the control group (all P<0.001). In terms of the degree of satisfaction with teaching, compared with the control group, the experimental group had significantly higher degrees of satisfaction in the dimensions such as interest in learning, mastery of theoretical knowledge, teamwork and collaboration abilities, self-learning ability, and self-presentation ( P=0.005, 0.009, 0.001, 0.016, and 0.005). In addition, the experimental group had a significantly higher degree of overall satisfaction with teaching than the control group ( P=0.006). Conclusion:Flipped classroom combined with PBL has a good teaching effect in the Diagnostic Audiology course and thus holds promise for further application.

OBJECTIVE To prepare a new antibacterial agent triggered by near infrared light to combat bacterial infection and promote wound healing. METHODS The synthesis of antibacterial agengt was supported by the results from transmission electron microscopy, Ultraviolet-visible absorption spectroscopy and Fourier-transform infrared spectroscopy. The antibacterial agent was irradiated under near infrared(NIR) laser with different concentrations to study the photothermal properties. Release of ciprofloxacin from the antibacterial agent was determined under different conditions. Observed antibacterial activity of the agent by spread plate method and bacterial growth curve. The infected wound was made on the back skin of mice, and the mice were treated with different methods to observe the healing process of the wound and study its influence on the wound healing. RESULTS The synthesized antimicrobial agent could be heated repeatedly without attenuation under near-infrared light, and could still reach a high temperature of 45 ℃ at a low concentration of 125 µg·mL-1. At the same time, it could promote the release of loaded antibiotics, and the release rate reached 86%. Compared with 200 µg·mL-1 solution obtained by physical mixing of polydopamine and ciprofloxacin, the synthesized antimicrobial agent combined with near-infrared light showed more excellent antibacterial ability, and the bacteriostatic rate against Escherichia coli and Staphylococcus aureus was 99.9%. Antimicrobial agents with concentrations of only 0.312 5 µg·mL-1 and 1.25 µg·mL-1 combined with near infrared light significantly inhibited the growth of Escherichia coli and Staphylococcus aureus. Through the mouse skin defect model infected by Staphylococcus aureus, it was proved that the synthetic antibacterial agent still had excellent antibacterial effect in practical application, and could accelerate the healing of infected wound. CONCLUSION The synthesized antimicrobial agents have excellent antibacterial effect in vitro, and still have good antibacterial effect and promote wound healing under the conservative power irradiation without causing skin damage in vivo.

Herein, we designed a dual-response shape transformation and charge reversal strategy with chemo-photodynamic therapy to improve the blood circulation time, tumor penetration and retention, which finally enhanced the anti-tumor effect. In the system, hydrophobic photosensitizer chlorin e6 (Ce6), hydrophilic chemotherapeutic drug berberrubine (BBR) and matrix metalloproteinase-2 (MMP-2) response peptide (PLGVRKLVFF) were coupled by linkers to form a linear triblock molecule BBR-PLGVRKLVFF-Ce6 (BPC), which can self-assemble into nanoparticles. Then, positively charged BPC and polyethylene glycol-histidine (PEG-His) were mixed to form PEG-His@BPC with negative surface charge and long blood circulation time. Due to the acidic tumor microenvironment, the PEG shell was detached from PEG-His@BPC attributing to protonation of the histidine, which achieved charge reversal, size reduction and enhanced tumor penetration. At the same time, enzyme cutting site was exposed, and the spherical nanoparticles could transform into nanofibers following the enzymolysis by MMP-2, while BBR was released to kill tumors by inducing apoptosis. Compared with original nanoparticles, the nanofibers with photosensitizer Ce6 retained within tumor site for a longer time. Collectively, we provided a good example to fully use the intrinsic properties of different drugs and linkers to construct tumor microenvironment-responsive charge reversal and shape transformable nanoparticles with synergistic antitumor effect.

ObjectiveTo explore the oral health status and oral health knowledge of women who are preparing for pregnancy in Shanghai so as to provide information on oral health. MethodsThe quota sampling method was adopted for 203 women preparing for pregnancy selected as the survey subjects in December 2019. Their oral health status was checked through oral examinations， and their awareness of oral health knowledge was investigated through questionnaire surveys. ResultsOral examination showed that in 203 women， the caries rate was 70.44%， the periodontal health rate was 4.43%， the dental calculus detection rate was 83.25%， the gingival bleeding detection rate was 59.61%， the shallow periodontal pocket rate was 9.85%， the deep periodontal pocket rate was 0.99%， and the detection rate of impacted teeth was 45.45%. The rate of women who answered all the questions in the questionnaire correctly was 0. ConclusionThe oral health of women preparing for pregnancy needs to be improved， and the level of oral health awareness needs to be raised urgently. The research results will help formulate and implement standardized oral health promotion policies.

Objective:To provide consistent data basis for the application of reference intervals for children blood cell analysis in different testing systems.Methods:According to the requirements of American Institute for Clinical and Laboratory Standardization (CLSI) EP9-A3 document, 45 samples were collected and Sysmex XN20-A1 were used as reference system. Beckman DxH800, Siemens ADVIA 2120i, and Mindray BC5310 were comparison systems. Complete blood count and leukocyte classification were performed by four systems. The outliers of the detection results were tested by the generalized extreme student deviate (ESD) method. An optimal regression model was selected by scatter diagram, deviation diagram and frequency distribution diagram, which was used to fit the regression equation and calculate the deviation at the medical decision level and reference interval. The acceptable range for blood count deviation was cited from the Analytical Quality Specifications for Routine Tests in Clinical Hematology. The acceptable range for leukocyte classification was based on the EQA program of Royal College of Pathologists of Australasia (RCPA).Results:After the outliers were deleted, the scatter plot showed a linear relationship between the reference system and the three comparison systems. The deviation plot showed that the differences were variable. Deming regression or Passing-Bablok regression was selected according to the data distribution. The determination coefficient R2 of reference system and three comparison systems ranged from 0.95 to 0.99 in blood count and leukocyte classification. At the upper and lower limits of the reference interval, the deviations between XN-20A1 and ADVIA 2120 system were all acceptable, except for MONO# at 0.12×10 9/L. The deviations of all parameters at medical decision level were within acceptable ranges. The lower limit of PLT is partially unacceptable at the level of medical decision related to treatment and prognosis. Conclusions:The results of complete blood count and leukocyte classification in reference system and the comparison system had good consistency within the children′s reference interval. Our study provided a scientific basis for the feasibility of adopting a unified reference interval for different detection systems.

Objective:To explore the relationship between blood test indicators and their changes and impaired fasting blood glucose, and to conduct risk prediction research.Methods:This study selected people who underwent a physical examination at a health management center in Jinan from 2018 to 2019, with an interval of 6 months or more between the two physical examinations, and had no history of diabetes and normal fasting blood sugar during the first year of the physical examination. We took the fasting blood glucose level in the second year as the dependent variable, and took the general examination and blood test indicators in the first year as well as the changes of these indicators as independent variables to construct the model. First, the random forest model was used to screen the independent variables, and then the logistic regression model is fitted to calculate the effect values of the independent variables.Results:A total of 4 416 subjects were enrolled in this study. After a 1-year follow-up, 3.45% (133/3 851) subjects developed prediabetic blood glucose, and 0.42% (16/3 851) developed diabetic blood glucose. The sensitivity of the model using blood test indicators to predict the risk of impaired fasting blood glucose after 1 year was 67.1%, and the specificity was 100.0%. The risk of impaired fasting blood glucose after 1 year was high in the population with older age ( OR value was 1.024, 95% CI 1.014-1.035), higher systolic blood pressure ( OR value was 1.018, 95% CI 1.011-1.025), higher body mass index ( OR value was 1.079, 95% CI 1.036-1.125), higher uric acid ( OR value was 1.003, 95% CI 1.002-1.005), higher glutamyl transpeptidase ( OR value was 1.006, 95% CI 1.003-1.010), lower creatinine ( OR value was 0.971, 95% CI 0.957-0.985), lower AST/ALT ( OR value was 0.614, 95% CI 0.411-0.917)) and lower estimated glomerular filtration rate ( OR value was 0.972, 95% CI 0.958-0.988). The sensitivity of the model using the changes of blood test indicators to predict the risk of impaired fasting blood glucose after 1 year was 65.2%, and the specificity was 99.7%. The risk of impaired fasting blood glucose is high in the population with increased triglycerides ( OR value was 1.152, 95% CI 1.057-1.257), increased alkaline phosphatase ( OR value was 1.021, 95% CI 1.012-1.030), increased albumin ( OR value was 1.087, 95% CI 1.029-1.148), increased aspartate aminotransferase ( OR value was 1.006, 95% CI 1.003-1.009), increased weight ( OR value was 1.049, 95% CI 1.019-1.081) within 1 year. Conclusions:The possibility of impaired fasting blood glucose after 1 year is high in the population with older age, higher systolic blood pressure, higher body mass index, higher uric acid, higher glutamyl transpeptidase, lower creatinine, lower AST/ALT and lower estimated glomerular filtration rate. The possibility of impaired fasting blood glucose is high in the population with increased triglycerides, increased alkaline phosphatase, increased albumin, increased aspartate aminotransferase and increased weight with in 1 year. When the above situation occurs in the physical examination, the blood glucose should be monitored and timely intervention should be taken to prevent the development of diabetes.

Adoptive cellular immunotherapy has been widely recognized in recent years due to its remarkable results, especially the success of CD19-specific chimeric antigen receptor (CAR) autologous T cell therapy for malignant hematoma. Previous studies have found the existence of tumor immune microenvironment, heterogeneous targets, and immunosuppressive receptors in solid tumors, which has led to the shortcomings of CAR-T treatment of solid tumors. This article proposes the methods to improve CAR-T cells to increase T cell infiltration, co-expression of cytokines and enzymes and modification of related receptors in order to enhance the anti-solid tumor activity of CAR-T, laying a theoretical foundation for the follow-up CAR-T cell treatment of solid tumors.