Objective To propose a human-machine coupling dynamics modeling method based on virtual muscles, so as to quantitatively analyze the characteristics of human-computer interaction force and muscle activation of the musculoskeletal system. Methods First, in the gait experiment of wearing exoskeleton, the human motion capture system and self-developed mechanical monitoring device were used to obtain the wearer’s walking dynamics, electromyography (EMG) signals, exoskeleton drive status and local human-computer interaction information. The human-machine coupling model was established in modeling environment of the bone system, and the gait experiment data and the exoskeleton joint torques were used as driving information of the coupling model to perform inverse mechanical calculations. Finally, by adjusting strength and stiffness parameters of the virtual muscles, the real data of the model was compared with the experimental test result, to quantitatively evaluate effectiveness of the human-machine coupling model of the lower extremity exoskeleton. Results The normal interaction force calculated by inverse dynamics of the coupled model and the activation of lower limb muscles had a good consistency in response curve trend compared with measurement results of the gait experiment, and the interaction force results had a high degree of correlation (r=0.931, P<0.01), the root mean square error was small, and the peak error of lower limb muscle activation was lower than 5%. Conclusions The human-machine coupling model proposed in this study can effectively calculate the interaction force between human and exoskeleton. The establishment of the coupling model provides a theoretical basis for verification and iteration of the exoskeleton structure optimization and control algorithm, as well as performance evaluation on mobility assistance effects of the exoskeleton.

Objective:To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of stiff kyphosis.Methods:From January 2016 to April 2018, 12 patients with stiff kyphosis in our department were treated with middle-column preserved pedicle subtraction closing-opening wedge osteotomy. The patients' operative time, intraoperative blood loss, postoperative drainage, surgical complications, low back pain and leg pain visual analogue scale (VAS), Oswestry dysfunction index (ODI) score, and SF-36 were recorded.These parameters were compared at preoperative, postoperative, and at the final follow-up. Coronal parameters included lumbar scoliosis Cobb angle, C 7 vertebral body center to humeral vertical line distance (C 7PL-CSVL), whilesagittal parameters includedlumbar Lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittalvertical axis (SVA). Results:All of 12 patients successfully completed the operation.The mean operation time was 238.20±65.95 min, the mean intraoperative blood loss was 440.50±133.60 ml.The patients’ODI score was 65.92%±6.96% at the preoperative, and 21.00%±3.19% at the final follow-up. The difference was statistically significant ( t=20.32, P<0.0001).The VAS score of back pain was 6.00±0.95 at preoperative, 2.33±0.89 at 3 months postoperatively, and 1.42±0.51 at the final follow-up. The VAS score of leg pain was 6.91±1.24 at preoperative, 2.50±1.00 at 3 months postoperatively, and1.50±0.52 at the final follow-up. There was significant difference in SF-36 at preoperative and at final follow-up ( P<0.05). The differences in LL, SS, PT and SVA at the preoperative and at final follow-up were statistically significant ( F=17.47, P<0.001; F=5.015, P=0.0125; F=14.66, P<0.001; F=81.11, P<0.001) . There was significant difference in lumbar scoliosis Cobb angle and C 7PL-CSVL at the preoperative and at final follow-up ( F=87.19, P<0.001; F=100.9, P<0.001) . Conclusion:The advantages of this surgical procedure includesimple operation, reducedsurgery time, and shorten intraoperative bleeding, which can effectively relief clinical symptoms, improve the quality of life, correctkyphosis, and maintain the patient's spinal-pelvic balance.

Objective:To investigate the changes of mean venous sinus pressure (MVP) and trans-stenosis pressure gradient in patients with idiopathic intracranial hypertension (IIH) under awake setting and general anesthesia.Methods:Thirty-eight patients with IIH accepted venous sinus stent implantation in our hospital from January 2010 to January 2020 were chosen in our study; their clinical data were analyzed retrospectively. The manometry results of these 38 patients were recorded under awake setting and general anesthesia before stenting; MVP and trans-stenosis pressure gradient were obtained and compared.Results:MVP in the superior sagittal sinus, torcular, transverse sinus and sigmoid sinus showed no significant difference between patients under awake setting and general anesthesia ( P>0.05). Mean trans-stenosis pressure gradient in patients under awake setting ([22.784±7.606] mmHg) was significantly higher as compared with that in patients under general anesthesia ([18.388±8.992] mmHg, P<0.05). Conclusion:Mean trans-stenosis pressure gradient in patients under awake setting is higher as compared with that in patients under general anesthesia, and selection for venous sinus stent implantation should be decided by trans-stenosis pressure gradient in patients under awake setting.

Total 268 patients underwent endoscopic thyroidectomy via upper anterior thoracic approach in Wenling First People's Hospital from June 2005 to July 2015, and skin burn occurred in 21 cases(7.8%).The causes of skin burns were shallower level of built space in 9 cases(43%), mismanagement for skin bleeding in 11 cases(52%),and improper separation of sternocleidomastoid region in 1 case(5%).After management 12 cases of subcutaneous ecchymosis or blisters(57%)were healed without pigmentation, 3 cases of skin necrosis(14%)were healed with scars, 4 cases of burned skin rupture treated with intradermal suture(19%)were healed by first intension and with minor scars,2 cases of burned skin rupture treated with catheter drainage(10%)were healed with obvious scars.The results show that correct level of puncture and proper management of skin bleeding can prevent skin burn, and proper treatments of skin burn can reduce the skin scars.

Objective To investigate the diagnostic value of susceptibility weighted imaging ( SWI) in patients with mild traumatic brain injury(MTBI).Methods From June 2016 to October 2017,a retrospective analysis of 89 patients with MTBI (Glasgow score 13 to 15) in the First People's Hospital of Xiaoshan District was conducted.All patients were given head CT ,MRI and SWI within 1 week after admission.Combined with CT and phase diagram ,after removing blood vessels ,calcification and skull base artifact ,the low signal intensity on the SWI was cerebral contusion and hemorrhage.The sites,the number and the size of lesion detected on CT ,MRI and SWI images were recorded and analyzed with clinical symptoms.Results According to the presence or absence of clinical symptoms in the group ,the detection rates of microbleeds hemorrhage in patients with traumatic cerebral by SWI were 94.4%,54.2%,100.0%, 95.5%,respectively,which were higher than those by CT (16.6%,4.2%,15.0%,4.5%) and MRI conventional sequences(33.3%,8.3%,20.0%,13.6%),the differences were statistically significant (χ2＝6.633,P＝0.010;χ2＝4.260,P＝0.039,all P ＜0.05),especially in MTBI patients with a history of transient coma or persistent clinical symptoms after trauma(the detection rate was 100.0%).Conclusion Compared with conventional CT and MRI,the micro-contusion and small hemorrhagic lesions of SWI is more accurate and important in the diagnosis of MTBI,and has a significant prognostic value for clinical treatment and judgment of patients with MTBI .

Objective To evaluate the clinical safety and efficacy of LVIS stent (a low profile knitting designed self-expandable stent) in assisting endovascular embolization for intracranial saccular aneurysms.Methods A total of 127 patients with intracranial saccular aneurysm,who were admitted to authors' hospital during the period from April 2014 to June 2016 to receive LVIS stent-assisted endovascular embolization,were retrospectively analyzed.The safety of the operation,the immediate postoperative outcomes,the recurrence rate,and the clinical and radiographic follow-up results were analyzed.Results A total of 130 LVIS stents were successfully implanted in the 127 patients with intracranial saccular aneurysm,implantation failure was seen in one patient,the technical success rate was 99.2％.During or after the endovascular embolization process in-stent thrombosis was observed in 7 patients (7/127,5.5％).Neither perioperative bleeding nor death occurred.Immediately after the operation,complete occlusion of the aneurysm was obtained in 112 aneurysms (88.1％) and neck remnant was observed in 15 aneurysms (11.9％).The patients were followed up for a mean period of 8 months.Follow-up angiography was performed in 37 patients,which showed that complete occlusion of the aneurysm was obtained in 33 patients (89.1％),and visualization of the aneurysm was seen in 4 patients (10.9％),including 3 patients who had aneurysm visualization immediately after embolization and one patient who had aneurysm recurrence.No death occurred.Conclusion The use of LVIS stent to assist endovascular embolization for intracranial saccular aneurysms is safe and effective,although its long-term effect needs further observation.

Objective To investigate the clinical value of splenic autotransplantation in patients with severe splenic trauma. Methods A prospective case-control study were performed in 120 patients with traumatic spleen rupture including the treatment group 72 patients and the control group 48 patients. The treatment group were treated with splenectomy plus spleen autotransplantation and the control group merely under splenectomy. Compare the operation time,operative blood loss,postoperative hospital stay,postoperative complications and the immune indexes before and different period after operation. Results Autologous spleen transplantation takes more time than merely splenectomy(P<0.05),but the operative blood loss,postoperative hospital stay and postopera-tive complications were no significant difference. 1 days after operation,the immune indexes of two groups were significantly lower than those before operation(P < 0.05),and 1 week after operation the immune indexes of two groups were significantly elevated(P<0.05).The immune indexes of the treatment group were better than those of the control group 3 months after operation(P < 0.05),and there was no significant difference compared with preoperative. Conclusion Splenectomy cause the decrease in the immune function,but the immune function can quickly rise to a certain level in short term.The splenic autotransplantation can effectively restore the immune func-tion to the preoperative level.

Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.

OBJECTIVETo explore the pathogenetic mechanism of a family affected with Waardenburg syndrome.

METHODSClinical data of the family was collected. Potential mutation of the MITF, SOX10 and SNAI2 genes were screened. Plasmids for wild type (WT) and mutant MITF proteins were constructed to determine their exogenous expression and subcellular distribution by Western blotting and immunofluorescence assay, respectively.

RESULTSA heterozygous c.763C>T (p.R255X) mutation was detected in exon 8 of the MITF gene in the proband and all other patients from the family. No pathological mutation of the SOX10 and SNAI2 genes was detected. The DNA sequences of plasmids of MITFand mutant MITFwere confirmed. Both proteins were detected with the expected size. WT MITF protein only localized in the nucleus, whereas R255X protein showed aberrant localization in the nucleus as well as the cytoplasm.

CONCLUSIONThe c.763C>T mutation of the MITF gene probably underlies the disease in this family. The mutation can affect the subcellular distribution of MITF proteins in vitro, which may shed light on the molecular mechanism of Waardenburg syndrome caused by mutations of the MITF gene.

Adolescent ; Adult ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Mutation ; genetics ; Pedigree ; Waardenburg Syndrome ; genetics ; Young Adult

OBJECTIVE: To evaluate the time and effect of shunt operation on cryptococcal meningitis.
 METHODS: A total 7 patients received shunt operation for the therapy of cryptococcal meningitis patients and the data was retrospectively analyzed.
 RESULTS: Intracranial hypertension-caused symptoms were resolved immediately. There was no complication, no infection dissemination and no recrudescence of cryptococcal meningitis. 
 CONCLUSION Shunt operation is effective for intracranial hypertension caused by cryptococcal meningitis. It does not affect the antifungal treatment.
Antifungal Agents ; therapeutic use ; Drainage ; Humans ; Intracranial Hypertension ; surgery ; Meningitis, Cryptococcal ; drug therapy ; surgery ; Recurrence ; Retrospective Studies