ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

OBJECTIVES: To compare the efficacy of transcatheter tricuspid valve replacement (TTVR) using Lux-Valve and Lux-Valve Plus in patients with severe tricuspid regurgitation. METHODS: A total of 28 consecutive patients with severe tricuspid regurgitation who underwent TTVR with Lux-Valve (n=14) or Lux-Valve Plus (n=14) in the First Affiliated Hospital of the Air Force Medical University from August 2019 to November 2023 were enrolled. Transthoracic echocardiography was performed in all patients before and 6 months after the TTVR. The ultrasound indexes were compared before and 6 months after the TTVR in all patients and between Lux-Valve and Lux-Valve Plus groups. RESULTS: Compared with the Lux-Valve group, the Lux-Valve Plus group showed significantly reduced intraoperative bleeding and shorter postoperative hospital stays (both P<0.05). Six months after the TTVR, none of the patients exhibited more than a mild tricuspid valve regurgitation, and none of the patients had moderate or above perivalvular leakage except for one patient in the Lux-Valve Plus group who had a separation of the clamping member from the anterior tricuspid leaflet. The incidence of perivalvular leakage was significantly lower in the Lux-Valve Plus group (14.29%, 2/14) than in the Lux-Valve group (64.29%, 9/14, P<0.05). At 6 months after operation, the right chamber volume and right ventricle middle transverse diameter were reduced (both P<0.05); the peak blood flow velocity across the tricuspid valve, peak pressure gradient across the tricuspid valve, mean blood flow velocity of tricuspid valve, mean pressure gradient across the tricuspid valve and velocity time integral were increased in both groups (all P<0.05).Compared with the Lux-Valve group, the Lux-Valve Plus group showed higher left ventricular ejection fraction at 6 months postoperatively (P<0.05), while the rest of the indicators were not statistically different (all P>0.05). CONCLUSIONS The efficacy of using Lux-Valve and Lux-Valve Plus for TTVR in patients with severe tricuspid regurgitation is comparable. Six months after the TTVR, the right side of the heart has undergone reverse remodeling.While Lux-Valve Plus offers greater minimally invasive benefits, valve selection should consider device-specific characteristics and differences in individual patients.
Humans ; Tricuspid Valve Insufficiency/surgery* ; Male ; Female ; Heart Valve Prosthesis Implantation/methods* ; Middle Aged ; Aged ; Tricuspid Valve/surgery* ; Heart Valve Prosthesis ; Treatment Outcome ; Echocardiography ; Adult ; Cardiac Catheterization/methods*

OBJECTIVES: To investigate the application of transesophageal echocar-diography assessment for mitral valve in patients with atrial septal defects undergoing repair surgery. METHODS: The study group comprised of thirty-two adult patients with atrial septal defect who underwent thoracoscopic repair surgery at the First Affiliated Hospital of the Air Force Medical University from March to September 2022. Two-dimensional and real-time three-dimensional transesophageal ultrasonography of the mitral valve were performed after anesthesia. The parameters of the mitral valve structure at the late diastolic and late systolic stages were recorded, including anteroposterior and left-right annular diameters, anterior and posterior valves lengths, the vertical distance from the coaptation point of leaflet zone 2 during systole to the annular plane (mitral valve coaptation depth) and mitral valve coaptation length. Data from 32 patients with normal intracardiac structure and no mitral valve regurgitation (control group) were also collected and compared with those of the study group. Concurrent mitral valvoplasty was performed during the atrial septal defect repair surgery for 7 patients with significant mitral valve structural abnormalities and 2 patients with significantly increased mitral regurgitation after cardiac resuscitation. The study group was followed up with transthoracic echocardiography for 2 years postoperatively. RESULTS: In the study group, 26 (81.3%) patients had varying degrees of mitral valve morphological abnormalities. Among them, 10 (31.3%) patients had short mitral valve coaptation length or depth, 12 (37.5%) patients had closure point malposition, and 4 (12.5%) patients had different bulge of anterior and posterior leaflets. Compared with the control group, the study group had significantly smaller systolic and diastolic mitral left-right annular diameter, mitral posterior valves lengths, mitral coaptation length or depth (all P<0.05), a higher pulmonary systemic flow ratio (P<0.01), and a lower maximum blood flow velocity across the mitral valve (P<0.05). After 2 years of follow-up, among the 9 patients who underwent concurrent mitral valvoplasty, the mitral valve maintained no or little regurgitation, and the average mitral valve pressure difference was less than 5 mmHg (1 mmHg=0.133 kPa). Among the 23 patients without concurrent mitral valvoplasty, 2 patients had moderate regurgitation 1 year after surgery, with a pulmonary/systemic flow ratio larger than 2.8. CONCLUSIONS Patients with large atrial septal defects often have abnormal mitral valve structure. Therefore transesophageal echocardiography is recommended for mitral valve assessment during the surgery. If significant mitral valve structural abnormalities are detected, concurrent mitral valvoplasty is recommended.
Humans ; Heart Septal Defects, Atrial/diagnostic imaging* ; Echocardiography, Transesophageal/methods* ; Mitral Valve/surgery* ; Adult ; Female ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnostic imaging*

Dislocation of acromioclavicular joint is a common injury, often caused by violent trauma. Dislocation of acromioclavicular joint can be classified into type Ⅰ to Ⅵ according to the Rockwood classification. High-grade dislocation of acromioclavicular joint usually requires surgical treatment. Although there are many surgical procedures for the treatment of acromioclavicular dislocation, none has become the gold standard of treatment. With the development of modern orthopedics, surgical treatment has changed, and more scholars are inclined to non-rigid and elastic fixation. Arthroscopic assisted treatment of acromioclavicular dislocation is favored by scholars because of its advantages of less trauma and better visual field. A consensus has been reached on the repair and reconstruction of coracoclavicular ligament during surgery, but there are different opinions on the repair and reconstruction of acromioclavicular ligament and the method. This article reviews the surgical methods of ligament repair and reconstruction of acromioclavicular dislocation in recent years, and provides reference for the treatment of acromioclavicular joint.

Objective:To investigate the clinical effect of arthroscopic combined fixation of acromioclavicular joint in the treatment of acute acromioclavicular dislocation.Methods:A retrospective controlled analysis was conducted on 40 patients with acute dislocation of the acromioclavicular joint were treated in Qinhuangdao First Hospital of Hebei Medical University from February 2021 to December 2023. There were 30 males and 10 females, aged from 22 to 54 years, with an average age of (40.55±7.75) years. The patients were divided into two groups based on the surgical method used. The observation group included 19 patients who were treated with Tightrope and suture to reconstruct the coracoclavicular ligament and acromioclavicular ligament, while the control group included 21 patients who were treated with Tightrope to reconstruct the coracoclavicular ligament only. All patients were followed up postoperatively, and their preoperative and postoperative data were recorded. The visual analogue scale (VAS) for pain, Constant score and coracoclavicular distance values of the two groups of patients before surgery and one year after surgery were recorded and compared. The changes of the internal fixation devices were observed. The measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and the t-test was used for comparison between groups, skewed continuous data were presented as [ M( Q1, Q3)], and intergroup comparisons were performed using the Mann-Whitney U test; the count data were expressed as cases and percentages [ n(%)], and the chi-square test was used for comparison between groups. Results:There was no significant difference in the general information (gender, age, affected side, time from injury to operation) between the two groups ( P>0.05). The last follow-up showed that two patients in the control group had early failure of the implant, one of whom had an infection after surgery, and one of whom had obvious displacement of the Tightrope early on. All patients in the observation group were healed by first intention, without any postoperative early complications such as wound infection, early failure of internal fixation, etc. There was no statistically significant difference in the VAS score between the two groups ( P>0.05); the Constant score 85(84, 89) of the observation group was higher than that of the control group 82(80, 85), and the difference was statistically significant ( P<0.05); the VAS score and Constant score of both groups after surgery were significantly improved compared with those before surgery ( P<0.05). One year after operation the coracoclavicular distance was 8.5(8.0-8.8) mm in observation group, and 10.3(9.7, 10.6) mm in control group ( P<0.05). Conclusions:The method of reconstructing the coracoclavicular ligament and acromioclavicular ligament complex fixation with Tightrope and suture using arthroscopy is reliable and has fewer postoperative complications. It is a better method than using Tightrope alone to fix the coracoclavicular ligament for the treatment of acute Rockwood Ⅲ to Ⅴ type acromioclavicular dislocation.

Objective To compare blood flow velocity measurements obtained using two different color Doppler imaging(CDI)devices with linear probes of varying frequencies.Methods CDI measurements were performed in 99 eyes of 50 participants from Shenyang Aier Excellent Eye Hospital using two different CDI devices,Apogee Type3500 and Esaote MyLab 7 eHD.These measurements included peak systolic velocity(PSV),end-diastolic velocity(EDV),and resistance index(RI)of the ophthalmic artery(OA),central retinal artery(CRA),and short posterior ciliary arteries(SPCA).The differences in measurements between the two devices were analyzed using a paired t-test.The level of agreement between the two CDI devices was calculated using the Bland-Altman method,and the concordance correlation co-efficient(CCC)was calculated.Results There was a statistically significant difference between the two CDI devices in the PSV,EDV of the OA,CRA,and SPCA,and RI of the CRA and SPCA.The PSV and EDV of each vessel were higher in Apogee than in Esaote,and the RI of the CRA and SPCA were lower for Apogee than for Esaote(P＜0.05).The CCC demonstrated poor overall concordance ranging from 0.136 to 0.517.Conclusion The consistency of most measurements obtained from both devices is poor.CDI inter-device reproducibility is unreliable,even when the measurements are conducted consecutively by a single experienced ultrasonographer.

OBJECTIVE: To investigate the effectiveness of knee arthroscopy with wire anchor nailing composite double pulley technique in the treatment of anterior cruciate ligament (ACL) tibial avulsion fracture involving the anterior root of the lateral meniscus (LM). METHODS: Clinical data of 35 patients with ACL tibial avulsion fracture involving the anterior root of the LM admitted between January 2019 and September 2023 and met the selection criteria were retrospectively analysed. There were 20 males and 15 females; ages ranged from 10 to 57 years, with a mean of 29 years. The time from injury to surgery ranged from 3 to 20 days, with a mean of 9.6 days. Meyers-McKeever classification included 5 cases of type Ⅱ, 12 cases of type Ⅲ, and 18 cases of type Ⅳ. Preoperative anterior knee instability Lachman test and anterior drawer test were positive. The anterior root of the LM as well as the avulsion fracture block were fixed using suture anchor nails compounded with double pulley technique under arthroscopy. Postoperative X-ray films were performed to assess fracture healing; knee stability was assessed using the anterior drawer test and Lachman test, anterior laxity of the knee was measured by KT-2000, and knee function was assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score; at last follow-up, the recovery of the meniscus was assessed using the McMurry test and knee hyperextension test. RESULTS: All the patients were successfully operated, the operation time ranged from 56 to 78 minutes,with an average of 67.6 minutes, and there was no nerve or blood vessel injury during operation. Thirty-five cases were followed up 12-18 months with an average of 15.1 months. During the follow-up, there was no infection, knee stiffness, loosening of internal fixation, fracture displacement, or re-fracture. The fractures all healed, with a clinical healing time of 8-15 weeks, averaging 10.9 weeks. At last follow-up, 4 patients had weakly positive anterior drawer test and Lachman test, and the rest were negative; McMurry test and knee hyperextension test were negative; no patient complained of knee extension pain or straightening obstacles, and all the patients resumed their normal life or sports and labour; 16 patients with unclosed epiphyses did not have any epiphyseal injuries or growth disorders. Lysholm score, IKDC score, and KT-2000 anterior knee laxity at last follow-up significantly improved when compared with preoperative ones ( P<0.05). CONCLUSION The treatment of ACL tibial avulsion fracture involving the anterior root of the LM with suture anchor composite double pulley technique can effectively fix the anterior root of the LM while fixing the avulsion fracture block, and better restore the function and stability of the knee joint.
Humans ; Male ; Female ; Adult ; Arthroscopy/methods* ; Adolescent ; Retrospective Studies ; Tibial Fractures/surgery* ; Young Adult ; Middle Aged ; Fractures, Avulsion/surgery* ; Fracture Fixation, Internal/instrumentation* ; Anterior Cruciate Ligament Injuries/surgery* ; Child ; Treatment Outcome ; Suture Anchors ; Menisci, Tibial/surgery* ; Tibial Meniscus Injuries/surgery* ; Bone Nails ; Knee Joint/surgery*

Objective:Exploring the efficacy and safety of the combination of programmed cell death protein 1 (PD-1) inhibitors with chemotherapy for the treatment of local recurrence at the primary tumor site of esophageal squamous cell carcinoma (ESCC) following definitive chemoradiotherapy.Methods:Seventy-six patients with local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy, who were treated at the Cancer Hospital Affiliated with Nanjing Medical University from January 2019 to January 2024. All patients received treatment with a PD-1 inhibitor combined with chemotherapy, and the short-term efficacy, long-term efficacy, and adverse reactions were observed. Univariate and multivariate Cox regression models were employed to identify the factors influencing overall survival (OS) and after-recurrence survival (ARS).Results:Among the 76 patients, 7 achieved partial response, 35 had stable disease, and 34 experienced progressive disease. The objective response rate was 9.2% (7/76), and the disease control rate was 55.3% (42/76). With a median follow-up time of 23.1 months, 33 out of 76 patients died. The median survival time was 38.5 months (95% CI: 29.6-47.3 months); the 1-year, 2-year, and 3-year OS were 94.5%, 66.6%, and 51.7%, respectively. The median ARS was 14.7 months (95% CI: 10.4-19.1 months); the 6-month, 12-month, and 24-month ARS were 85.8%, 59.6%, and 25.7%, respectively. Univariate analysis showed that the initial radiation dose, the Eastern Cooperative Oncology Group (ECOG) performance status of patients after recurrence, the recurrence-free interval (RFI), and the approach to chemotherapy treatment following local esophageal recurrence were factors affecting OS and ARS ( P＜0.05). Multivariate analysis showed that initial radiotherapy dose ( HR=0.268, 95% CI: 0.100-0.720), the ECOG performance status after recurrence ( HR=4.106, 95% CI: 1.228-13.728), and RFI ( HR=0.248, 95% CI: 0.106-0.582) were independent prognostic factors for OS. Additionally, the initial radiation dose ( HR=0.289, 95% CI: 0.098-0.853) and the ECOG performance status after recurrence ( HR=5.143,95% CI:1.404-18.838) were independent prognostic factors for ARS. The incidence of treatment-related adverse-reactions was 85.5% (65/76). Grade 3 or higher treatment-related adverse reactions primarily included anemia in 4 cases, leukopenia in 8 cases, neutropenia in 9 cases, thrombocytopenia in 2 cases, liver function abnormalities in 4 cases, and elevated troponin T in 2 cases. There were no cases of treatment-related mortality. Conclusions:The combination of PD-1 inhibitors with chemotherapy is safe and effective for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy and can provide survival benefits for patients. This approach can be considered as a therapeutic option for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy.

This study investigated the incidence,prevention and control measures,diagnostic and treatment methods,and treatment costs of hoof diseases in dairy cows across 87 large-scale farms,aiming to provide a scientific basis and new insights for the treatment and prevention of hoof disea-ses in dairy herds.The results showed that the incidence rate of lameness in most farms was con-trolled between 3％and 7％,with a cure rate above 85％.The importance ranking of prevention and control measures was as follows:hoof trimming＞leveling the ground＞disinfection＞regular foot baths＞manure removal＞locomotion(lameness)scoring.The importance ranking of treat-ment measures was:hoof trimming＞disinfection and astringents＞anti-inflammatory treatment＞antibiotics＞block application＞traditional Chinese medicine(fire therapy).Economic analysis showed that the treatment cost of lameness was closely related to the incidence rate,with higher treatment expenses observed in farms with higher incidence rates.Farms with higher individual milk yields typically had more efficient disease management strategies,leading to lower treatment costs.Large-scale farms should continuously optimize management practices to reduce the occur-rence of lameness and improve overall farm efficiency by using effective treatment strategies.