BACKGROUND: The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR). METHODS: A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS. RESULTS: DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2 = 19.57, P <0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS ( χ2 = 17.08, P <0.05). The RTS rate was influenced by SNQs of the graft's tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test ( χ2 = 13.49, P <0.01), objective IKDC-2000 ( χ2 = 27.02, P = 0.002), and anterior instability test ( χ2 = 9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57 ± 7.72, CASBR: 83.00 ± 12.71, ASBR: 83.21 ± 11.95; F = 10.452, P <0.01) and IKDC-2000 score (DBR: 90.95 ± 7.00, CASBR: 84.64 ± 12.68, ASBR: 83.63 ± 11.41; F = 11.78, P <0.01). CONCLUSION: For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS. TRIAL REGISTRATION ClinicalTrials.gov (NCT05400460).
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Male ; Female ; Adult ; Anterior Cruciate Ligament Injuries/surgery* ; Young Adult ; Return to Sport ; Adolescent ; Anterior Cruciate Ligament/surgery* ; Treatment Outcome

OBJECTIVE: To explore decompression strategies for lateral lumbar spinal stenosis under unilateral biportal endoscopy (UBE) assistance. METHODS: A clinical data of 86 patients with lateral lumbar stenosis treated with UBE-assisted intervertebral decompression between September 2022 and December 2023 was retrospectively analyzed. There were 42 males and 44 females with an average age of 63.6 years (range, 45-79 years). The disease duration ranged from 6 to 14 months (mean, 8.5 months). Surgical levels included L _{2, 3} in 3 cases, L _{3, 4} in 26 cases, L _{4, 5} in 42 cases, and L ₅, S ₁ in 15 cases. According to Lee's grading system, there were 21 cases of grade 1, 37 cases of grade 2, and 28 cases of grade 3 for lumbar spinal stenosis. Based on the location of stenosis and clinical symptoms, the 33 cases underwent interlaminar approach, 7 cases underwent interlaminar approach with auxiliary third incision, 26 cases underwent contralateral inclinatory approach, and 20 cases underwent paraspinal approach; then, the corresponding decompression procedures were performed. Visual analogue scale (VAS) score was used to evaluate lower back/leg pain before operation and at 1 and 3 months after operation, while Oswestry disability index (ODI) was used to evaluate spinal function. At 3 months after operation, the effectiveness was evaluated using the modified MacNab evaluation criteria. The spinal stenosis and decompression were evaluated based on Lee's grading system using lumbar MRI before operation and at 3 months after operation. RESULTS: All procedures were successfully completed with mean operation time of 95.1 minutes (range, 57-166 minutes). Dural tears occurred in 2 cases treated with interlaminar approach with auxiliary third incision. All incisions healed by first intention. All patients were followed up 3-10 months (mean, 5.9 months). The clinical symptoms of the patients relieved to varying degrees. The VAS scores and ODI of lower back and leg pain at 1 and 3 months after operation significantly improved compared to preoperative levels ( P<0.05), and the indicators at 3 months significantly improved than that at 1 month ( P<0.05). According to the modified MacNab evaluation criteria, the effectiveness at 3 months after operation was rated as excellent in 52 cases, good in 21 cases, and poor in 13 cases, with an excellent and good rate of 84.9%. No lumbar instability was detected on flexion-extension X-ray films during follow-up. The Lee's grading of lateral lumbar stenosis at 2 days after operation showed significant improvement compared to preoperative grading ( P<0.05). CONCLUSION For lateral lumbar spinal stenosis, UBE-assisted decompression of the spinal canal requires the selection of interlaminar approach, interlaminar approach with auxiliary third incision, contralateral inclinatory approach, and paraspinal approach based on preoperative imaging findings and clinical symptoms to achieve better effectiveness.
Humans ; Spinal Stenosis/diagnostic imaging* ; Female ; Male ; Middle Aged ; Decompression, Surgical/methods* ; Aged ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Retrospective Studies ; Treatment Outcome

BACKGROUND:Traditional scoliosis orthosis has some disadvantages,such as complex manufacturing process,long processing cycle,poor fit and so on.Three-dimensional printed scoliosis orthosis has the advantages of high manufacturing precision and personalization. OBJECTIVE:To evaluate the efficacy of three-dimensional printed scoliosis orthosis for scoliosis based on multi-criteria decision model. METHODS:Clinical data of 72 patients with scoliosis admitted to Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to October 2022 were retrospectively collected and divided into two groups according to the treatment of orthosis.Study group(n=23)received three-dimensional printed scoliosis orthosis.Traditional group(n=49)received the traditional polypropylene spine brace treatment.The clinical efficacy and complications were compared between the two groups.A multi-criteria decision model for the treatment of scoliosis with three-dimensional printed scoliosis orthosis was established,and the stability of the benefit value,risk value and decision model of the two groups were evaluated. RESULTS AND CONCLUSION:(1)Compared with the traditional group,there were significant differences in the top vertebral offset distance,Cobb angle,top vertebral rotation,Functional Movement Screen score,visual analog scale score and total effective rate in the study group at 6 months after surgery(P<0.05).(2)Among the benefit indexes,Cobb angle had the greatest impact on the condition of patients,while the risk indexes had the greatest impact on dyspnea.(3)The benefit values of the study group and the traditional group for scoliosis were 79 and 64,and the risk values were 74 and 57,respectively.The combined benefit and risk values found that the benefit-risk value of the study group was 16 higher than that of the traditional group.(4)In the range of 0-100%relative risk weight,the benefit-risk value of the study group was always higher than that of the traditional group,which proved that the multi-criteria decision-making model had good stability.(5)It is indicated that three-dimensional printed scoliosis orthosis can better restore the physiological curvature of scoliosis and improve the efficiency of treatment.

Objective: To investigate the effect of Guangdong Shenqu (GSQ) on intestinal flora structure in mice with food stagnation through 16S rDNA sequencing. Methods: Mice were randomly assigned to control, model, GSQ low-dose (GSQL), GSQ medium-dose (GSQM), GSQ high-dose (GSQH), and lacidophilin tablets (LAB) groups, with each group containing 10 mice. A food stagnation and internal heat mouse model was established through intragastric administration of a mixture of beeswax and olive oil (1:15). The control group was administered normal saline, and the model group was administered beeswax and olive oil to maintain a state. The GSQL (2 g/kg), GSQM (4 g/kg), GSQH (8 g/kg), and LAB groups (0.625 g/kg) were administered corresponding drugs for 5 d. After administration, 16S rDNA sequencing was performed to assess gut microbiota in mouse fecal samples. Results: The model group exhibited significant intestinal flora changes. Following GSQ administration, the abundance and diversity index of the intestinal flora increased significantly, the number of bacterial species was regulated, and α and β diversity were improved. GSQ administration increased the abundance of probiotics, including Clostridia, Lachnospirales, and Lactobacillus, whereas the abundance of conditional pathogenic bacteria, such as Allobaculum, Erysipelotrichaceae, and Bacteroides decreased. Functional prediction analysis indicated that the pathogenesis of food stagnation and GSQ intervention were primarily associated with carbohydrate, lipid, and amino acid metabolism, among other metabolic pathways. Conclusion The digestive mechanism of GSQ may be attributed to its role in restoring diversity and abundance within the intestinal flora, thereby improving the composition and structure of the intestinal flora in mice and subsequently influencing the regulation of metabolic pathways.

Objective:To analyze the current status of anesthesiology research in the world and China in 2023 and to identify the anesthesiology research hotspots using bibliometrics.Methods:The literature related to anesthesiology published in PubMed in 2023 was searched, and the country and author of the literature, as well as the key words of the literature were visually analyzed by using the software CiteSpace6.2. R4.Results:A total of 22 473 articles were included, the country with the largest number of publications was the United States, and China ranked second. The author with the highest number of publications in the field of anesthesiology in the worldwide in 2023 was Kaye Alan D from the United States. Chronic pain, general anesthesia and pain management were the research hotspots in the field of anesthesiology worldwide in 2023. The research hotspots in the field of anesthesiology in China focused on general anesthesia, oxidative stress and neuropathic pain.Conclusions:The United States is the leader in the research in the field of anesthesiology, with China following behind. The keywords of the literature in the field of anesthesiology between China and the world are roughly the same, reflecting the convergence of Chinese scientific research with global scientific research. Domestic anaesthesia practitioners can refer to or learn from the research hotspots of related countries and strengthen communication and cooperation between teams while conducting academic research.

Objective:To evaluate the performance and the accuracy of surgical robot for mandibular reconstruction based on intelligent surgical planning.Methods:115 CT scanning images of normal mandible (57 males, 48 females, 40.3±9.1 years old, from February 2010 to May 2019) and 115 CT scanning images of mandible with tumor (62 males, 53 females, 55.6±7.2 years old, from March 2008 to August 2019) from Shanghai Ninth People’s Hospital were selected. The surgical robot system including work station, UR robot, optical navigation system, 6 dimensional force senor and surgical instrument. A 3D V-Net for mandible preoperational segmentation from CT scans was proposed and used to segment the mandible of a 54-year-old male patient who received mandible reconstruction with fibular flaps. The machine learning algorithm was used to aid surgical planning for maxillo-mandibular defect by detecting landmarks. The accuracy was defined as the distance between corresponding landmarks on the intact mandible. The robot could locate the target according to surgical planning and perform fibula osteotomy through force-motion control. The CT scanning of limb and head from the patient (male, 54 years old) was used for phantom experiments. 30 osteotomies on 5 3D-priented resin phantom were carried out. The pre- and post-operative images were compared to calculate the accuracy. The descriptive results were in the format of Mean±SD.Results:The average accuracy of V-Net for mandible segmentation was 96.581% and the time cost was less than 30 seconds. The average error of feature points on mandible was (2.24±1.74) mm. The residual length error was (1.02±0.45) mm and angle error was (0.96±0.42) degree in robotic-assisted osteotomy according to 3 cases of phantom experiments. The surgical robot could perform osteotomy safely and steadily within 15 min.Conclusions:Intelligent surgical planning can precisely segment the mandible and determine its landmarks. Robot for mandibular reconstruction can perform fibular osteotomy precisely with the pre-operative planning.

Objective:To evaluate the performance and the accuracy of surgical robot for mandibular reconstruction based on intelligent surgical planning.Methods:115 CT scanning images of normal mandible (57 males, 48 females, 40.3±9.1 years old, from February 2010 to May 2019) and 115 CT scanning images of mandible with tumor (62 males, 53 females, 55.6±7.2 years old, from March 2008 to August 2019) from Shanghai Ninth People’s Hospital were selected. The surgical robot system including work station, UR robot, optical navigation system, 6 dimensional force senor and surgical instrument. A 3D V-Net for mandible preoperational segmentation from CT scans was proposed and used to segment the mandible of a 54-year-old male patient who received mandible reconstruction with fibular flaps. The machine learning algorithm was used to aid surgical planning for maxillo-mandibular defect by detecting landmarks. The accuracy was defined as the distance between corresponding landmarks on the intact mandible. The robot could locate the target according to surgical planning and perform fibula osteotomy through force-motion control. The CT scanning of limb and head from the patient (male, 54 years old) was used for phantom experiments. 30 osteotomies on 5 3D-priented resin phantom were carried out. The pre- and post-operative images were compared to calculate the accuracy. The descriptive results were in the format of Mean±SD.Results:The average accuracy of V-Net for mandible segmentation was 96.581% and the time cost was less than 30 seconds. The average error of feature points on mandible was (2.24±1.74) mm. The residual length error was (1.02±0.45) mm and angle error was (0.96±0.42) degree in robotic-assisted osteotomy according to 3 cases of phantom experiments. The surgical robot could perform osteotomy safely and steadily within 15 min.Conclusions:Intelligent surgical planning can precisely segment the mandible and determine its landmarks. Robot for mandibular reconstruction can perform fibular osteotomy precisely with the pre-operative planning.

Objective To develop a new type of locating rod with easy installation and high reliability for radiotherapy.Methods The locating rod was composed of a joining beam,two clamping buckles and buckle holders.The joining beam had the length being 530+03 mm.One of the buckles was put at one end of the beam,and the other slided along a stool.An eccentric wheel drove the sliding buckle to determine the space between two buckles,and a returning spring was involved in to enhance the compliance of the sliding buckle.Results The rod gained easy installation and operation,and was compatible with the bed board with the width of 5300 mm.There was no sideslip occurred after locking the rod,and the sideslip shift was not more than 1 mm in case of 20 kgf (1 kgf=9.8 N) lateral traction.Conclnsion The rod has high performances and meets clinical requirements.

Objective To construct the teaching model of medical statistics in universities of TCM through the questionnaire of knowledge,attitude and practice structure.Methods Medical statistics KAP questionnaire survey was conducted among postgraduates using proportional stratified sampling according to the grade.It describes the present situation and calculates the knowledge loss coefficient,knowledge demand index and behavioral application intensity of medical statistics.The Chi-square test was used to analyze the differences among different grades.Results 109 questionnaires were withdrawn.The recovery was 83.84％.45 cases (41.3％) were first year postgraduate,33 cases (30.3％) were 2nd year postgraduate,and 31 cases (28.4％) were 3rd year postgraduate.At the knowledge level,the knowledge loss coefficient of the second year postgraduates was 0.635,and there was no statistical difference (P=-0.651) vs the first year postgraduate (0.638).At the attitude level,Knowledge demand index had no statistical significance difference (P=0.213)between postgraduates in grade two (96.87％) and grade three (75.00％).Most medical postgraduates held positive attitudes toward medical statistics,hoping to strengthen the training of their application ability such as medical statistics in design and research thinking (29.18％),the statistical methods selection and the interpretation of the results (31.53％) and the statistical software operation (36.07％).At the practice level,the percentage of application intensity with statistical methods of third-year postgraduates (100.00％) was higher than the second-year postgraduates (37.50％),and the second-year postgraduates higher than the first-year postgraduates (20.45％).And with the growth of year,the percentage of application intensity was gradually increasing (P=O.O03).Among them,published scientific papers accounted for 16.5％,and 58.6％ paper grade concentrated in the core journals.Conclusion Application development should be enhanced by modularization teaching with practical issues.

Objective To explore the mechanism of hBUB1 gene in the developing of spontaneous abortion embryos with numerical chromosomal abnormalitv.Methods Quantitative real-time RT-PCR and Western blot were used to determine the mRNA and protein level of hsMAD2 gene both in spontaneous abortion embryos with numerical chromosomal abnormality(experimental group)and with numerical chromosomal normality(control group).Recombinant shRNA plasmids targeting hBUB1 gene was constructed to inhibit the expression of endogenous hBUB1 genes in embryonic cells.Interference efficiency was demonstrated by fluorescent quantitative PCR and Western blot.The inhibitory rate of cell proliferation was measured by MTT assay and cells-cycle was assessed by flow cytometry.Resuns Western blot analysis showed that protein level of hBUB1 in the experimental group was decreased signifieandv(the rate of positivity and strong positivity were 8%and 93.5%,respectively,P＜0.05)compared with the control group.The expression of hBUB1 gene in embryonic cells was significantly and specially inhibited by shRNA plasmids (the mRNA level before and after treatment witll RNAi were 0.196±0.067 and 0.042±0.006,respectively,P＜0.05).The inhibitory rate of cell proliferation was increased to 62%from 4%at 48 h after transfection.The rate of G2/M phase cells was decreased after transfection with efficient shRNA(control group:40.2%and 41.3%,test group:21.3%).Conclusions Down-regulation of hBUB1 gene leads to the inhibition of cell proliferation and the arrest of cell-cycle.It also probably plays an important role in the development of spontaneous abortion embryos with numerical chromosomal abnormality.The clinical relevance warrant further investigation.