Three-dimensional printed patient-specific instrumentation (3D-PSI) provides a precise and individualized treatment solution for unicompartmental knee arthroplasty (UKA). Currently, this technology is being applied in clinical practice and has demonstrated certain potential. Compared to conventional instrumentation (CI), 3D-PSI offers a broader range of indications, higher-quality preoperative planning, shorter surgical time, a smoother learning curve, more precise osteotomy and prosthesis placement, and better postoperative functional recovery. However, it still has limitations in the rotational alignment of the tibial component. Additionally, the higher cost for patients and increased hospital equipment investment make it less beneficial for surgeons already proficient in CI techniques. Further reliable evidence is needed to compare 3D-PSI with computer navigation and robotic technologies. This review summarizes the advantages and limitations of 3D-PSI assisted UKA and compares 3D-PSI with different auxiliary technologies.

Objective To analyze the correlation between the number of oil chambers,the proportion of phloem at cross-section of Aucklandiae Radix and the contents of costunolide and dehydrocostuslactone,and the correlation between inulin quantity,vessel quantity and polysaccharide content in powder characteristics,so as to explore the scientific basis for Aucklandiae Radix"identifying the quality based on appearance differentiation".Methods The constant values of the microscopic features of oil chambers,inulin and vessels were determined by cross-sectional permanent slice method,chloral hydrate method and counting analysis method,and the contents of costunolide and dehydrocostuslactone as well as polysaccharide content were determined by the high-performance liquid chromatography(HPLC)and the phenol-sulfuric acid method,respectively,and the correlation in the two groups of data was analyzed by statistical methods.Results There was a significantly positive correlation between the number of oil chambers per unit area in the cross-section of Aucklandiae Radix and the number of oil chambers per unit area in the phloem and the contents of costunolide and dehydrocostuslactone;there was a significantly positive correlation between the quantity of inulin in the powder of Aucklandiae Radix and the polysaccharide content;there was no correlation between the quantity of vessels and the polysaccharide content.Conclusion This study initially established a new method and a new technology for quality evaluation of Chinese herbal medicines based on the determination of microscopic characteristic constants of Aucklandiae Radix,which can provide a new technical method for the quality control of Aucklandiae Radix.

Objective:To investigate the effect of early protein supplementation on the clinical outcomes of elderly ICU patients with critically ill.Methods:The study was a post-hoc analysis of a multicenter, cluster randomized controlled trial (NEED trial), which aimed to evaluate the impact of feeding protocol on nutritional implementation and outcomes in ICU patients. It was planned to include elderly patients aged ≥70 years from the NEED trial, and patients who had not started nutritional therapy by the Day 3 after enrolment, stayed in the ICU less than 7 days, missing the primary outcome were excluded. The primary outcome of this study was 28-day mortality of enrolment. Patients were categorized into Q1 (<0.6 g/kg/d), Q2 (0.6-0.83 g/kg/d), and Q3 (≥0.83 g/kg/d) groups according to the tertiles of protein supply. The log-rank test was used to compare the Kaplan-Meier survival curves for 28-day mortality. The associations between different protein groups and 28-day mortality were tested by Cox proportional hazards regression models. Subgroup analysis was conducted in patients with high (mNUTRIC score≥5) nutritional risk or patients with baseline acute kidney injury.Results:A total of 789 elderly (≥70 years) patients was included in the study, with a mean protein amount of 0.69 (0.53, 0.91) g/(kg·d) during days 3-7 after ICU admission, and mean protein amounts in the Q1 low-protein group, the Q2 medium-protein group, and the Q3 high-protein group were 0.46 (0.36, 0.53), 0.69 (0.63, 0.76), and 1.03 (0.91, 1.23) g/(kg·d), respectively. The results showed that the medium protein group associated with lower 28-day mortality compared to the high protein group, and the association between the medium protein group and lower 28-day mortality still held after controlling for possible confounders by Cox multivariate regression analysis. In the high-nutritional risk subgroup (mNUTRIC≥5), a significant association was also found between the medium protein group and lower 28-day mortality.Conclusions:Early high protein supply are not beneficial for elderly ICU patients by this large sample size post-hoc analysis, and medium protein supply associate with lower 28-day mortality compared with the high protein group. This study may provide a theoretical basis for the optimal dose of early protein supply in elderly ICU patients, as well as a reference for clinical implementation.

Objective To compare the clinical effect of the small bone flap craniotomy and traditional craniotomy in the treatment of elderly patients with hypertensive striatocapsular hemorrhage .Methods According to the digital table ,80 patients with hypertensive striatocapsular hemorrhage were randomly divided into control group and treatment group ,40 cases in each group .The treatment group was treated with small bone flap craniotomy ,and the control group was treated with traditional craniotomy .The operative incision length ,intraoperative blood loss ,operation time,hematoma clearance rate,rebleeding rate,GCS score,postoperative pulmonary infection rate and GOS score in the 1 month after treatment were compared between the two groups .Results The operative incision length , intraoperative blood loss, operative time, GCS score after 1 week, pulmonary infection of the treatment group were (7.0 ±1.5)cm,(100 ±35)mL,(1.5 ±0.6)h,(12.5 ±1.4),25.0％,respectively,which of the control group were (18.0 ±4.5)cm,(500 ±85) mL,(2.2 ±0.8) h,(10.5 ±1.1),47.5％,respectively,the differences between the two groups were statistically significant (t=303.791,P=0.000;t=244.467,P=0.000;t=24.366,P=0.003;t=3.294,P=0.031;χ2 =4.381,P=0.036).The hematoma clearance rate,rebleeding rate of the treatment group were 90.0％,7.5％,respectively,which of the control group were 85.0％,10.0％,respectively,there were no statistically significant differences between the two groups (χ2 =0.457,P=0.499;χ2 =0.157,P=1.692).The prognosis of the patients in the treatment group was significantly better than those in the control group (Z=-2.022,P=0.043). Conclusion The small bone flap craniotomy in the treatment of hypertensive striatocapsular hemorrhage has the advantages of less trauma , shorter operative time , less intraoperative bleeding , high hematoma clearance rate , low rebleeding rate,low complication rate and good prognosis .

According to the locations of main hematomas,60 patients with hypertensive basal ganglia hemorrhage were surgically treated through different approaches from June 2014 to September 2017.Thirty six cases with anterior hematoma near the Sylvian point were treated through transsylvian-transinsular approach,24 cases with the posterior hematoma far from the Sylvian point were treated through translower-rolandic-point (transLRP) transinsular approach (n =11) or transsuperior-temporal-sulcus (transSTS) transinsular approach (n =13),respectively.All patients were followed up for at least 6 months and evaluated by Glasgow Outcome Scale.Fourteen patients showed good recovery,25 patients showed moderate disability,18 patients showed severe disability,one patients showed vegetative survival and two patients died.

Objective To investigate clinical application of lateral supraorbital approach in microsurgery for tuberculum sellae meningioma.Methods A retrospective analysis was performed of the 46 patients with tuberculum sellae meningioma who had received microsurgery at Department of Neurosurgery,The First Affiliated Hospital to Soochow University from January 2010 to September 2017.Of the 46 patients,the lateral supraorbital approach was applied in 18 and the pterional approach in 28.The excision of tumor,operation time,hospital stay and visual improvement were compared between the 2 operative approaches.Results There was no significant difference in tumor excision rate between the patients using the lateral supraorbital approach and those using the pterional approach (P＞0.05).The operation time and hospital stay for the patients using the lateral supraorbital approach were significantly less than for those using the pterional approach (P＜0.05).Of the 12 cases with preoperative visual deterioration in the former patients,5 obtained no obvious visual change but 7 visual improvement;of the 23 cases with preoperative visual deterioration in the latter patients,9 obtained no obvious change,12 visual improvement and 2 further visual deterioration.Conclusion Neuro-microsurgery via the lateral supraorbital approach is a safe and mini-invasive treatment for tuberculum sellae meningioma.

Objective To study the surgical treatment and clinical effect of growth hormone type pituitary tumor complica-ting cardiomyopathy .Methods Sixty-five cases of growth hormone type pituitary adenoma complicating cardiomyopathy in the hos-pital from June 2012 to June 2016 were selected and performed transsphenoidal approach pituitary adenoma resection .Then serum growth hormone level ,ECG results ,ultrasound cardiogram results and clinical symptoms were observed at 2 weeks after operation . Results The signs were significantly improved after surgery ,acromegaly and nasolabial hypertrophy were significantly improved , dizziness ,fatigue ,hypertension and hyperglycemia were significantly improved ;the average postoperative growth hormone level was (4 .37 ± 2 .03)μg/L ,which was significantly lower than (40 .27 ± 4 .18)μg/L before operation ,and the difference was statistically significant (P< 0 .01 );postoperative IVST ,LVIDd and LVPWT were significantly lower than those before operation ,and the difference was statistically significant (P<0 .01);postoperative average E/A and LVEF were significantly lower than those before operation ,and the difference was statistically significant (P<0 .01) .Conclusion Transsphenoidal pituitary tumor resection can re-duce the level of grow th hormone and improves the cardiac function .

Objective To study the effect of hydrogen sulfide (H2S) on acute cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) and explore its mechanism.Methods (1) A total of 48 adult male SD rats were randomly allocated into a normal group,a SAH group,a low dose NaHS group and a high dose NaHS group (n=12).Rat models of SAH were induced by injecting autologous blood into the prechiasmatic cistern.Rats in the later two groups were given 0.7 mg/kg and 2.8 mg/kg NaHS,respectively,0.5 h after modeling.Neurological scale scores were assessed 24 h after modeling;HE staining,TUNEL and immunohistochemical double-staining were employed to detect the morphology of approximated A2 blood vessel of anterior cerebral artery (ACA),tube wall thickness and endothelial cell apoptosis,respectively.(2) Brain microvascular endothelial cells (BMECs) were chosen and divided into blank control group,100 μmol/L OxyHb prevention group,25 μmol/L NaHS pretreatment group and 100 μmol/L NaHS pretreatment group.The cells were collected and observed 24 h after treatment,and then,the number of endotheliocytes was counted,and the Caspase-3 protein expression was detected by Western blotting.Results (1) The neurological scale scores (8.5±2.4) were significantly lower,the vessel wall ([43.5±6.2] μm) was significantly thickened,the lumen area ([30 488±938) μm2) was obviously reduced,and the number of TUNEL positive cells ([36.51±11.45]％) was remarkably increased in the SAH group as compared with those in the normal group (16.1 ±1.7,[25.8±3.5] μm,[51707± 1422] μm2 and [2.86±0.75]％ in turn,P＜0.05).The neurological scale scores (11.6±1.9 and 15.4±2.3) were significantly higher,the vessel wall ([34.7±3.7] and [31.7±4.6] μm) was significantly thinned,the lumen area ([41 463±1104] and [45 244±1217] μm2) was obviously increased,and the number of TUNEL positive cells ([17.14±5.36] and [8.10±4.62] ％) was remarkably reduced in the low dose NaHS group and high dose NaHS group as compared with those in the SAH group (P＜0.05).The neurological scale scores in high dose NaHS group were significantly higher than those in the low dose group and the number of TUNEL positive cells was signficantly smaller than that in the low dose group (P＜0.05).(2) The number of apoptotic endothelial cells ([40.56±9.85] ％) and the expression of Caspase-3 (0.395±0.122) in OxyHb prevention group were significantly larger/higher than those in the blank control group (P＜0.05).The number of apoptotic endothelial cells and the expression of Caspase-3 in the low dose group ([16.65± 6.35]％ and [0.223±0.083]) and high dose group([14.12±6.65] ％ and [0.208±0.104]) were obviously reduced as compared with those in the OxyHb prevention group,with significant differences (P＜0.05).Conclusion H2S can effectively expand cerebral vasospasm,and its vasoprotective mechanism may be through inhibiting vascular endothelial cell apoptosis.

Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model.Methods After baseline data were recorded,24 pigs were randomly allocated into three groups as follows:one SAP-alone group,and two SAP + ACS groups (decompression at 6 and 12 hours,respectively).We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium taurocholate to induce severe acute pancreatitis (SAP).Systemic hemodynamic profiles,urine output,systemic oxygenation,and serum biochemical parameters of the animals were obtained.Results After induction of ACS,the hemodynamics and oxygenation of the study animals deteriorated significantly.The survival time of the 12-hour group was significantly shortened (P =0.008 vs.6 hours).Early decompression (6 h) restored systemic hemodynamics,oxygenation,organ function,and inflammatory intensity to a level comparable to that of the SAP-alone group.In contrast,animals in 12-hour group developed more severe hemodynamic suppression,oxygenation and organ dysfunction and inflammatory process.For instance,the cardiac output levels in the three groups were 2.70 ±0.50 for the SAP group,2.75 ±0.48 for the 6 hour-group and 2.19 ±0.43 for the 12 hour-group.Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS,and also improve systemic hemodynamics,organ function and inflammatory intensity.