BACKGROUND:Studies have shown that posterior cruciate ligament injuries are associated with the anatomical morphology of the knee joint. OBJECTIVE:To explore anatomical morphological risk factors for posterior cruciate ligament injury. METHODS:The imaging data of 142 patients who visited Affiliated Hospital of Binzhou Medical University for knee joint problems from January 2015 to August 2022 were retrospectively analyzed.They were divided into posterior cruciate ligament injury group(n=71,including 49 males and 22 females)and posterior cruciate ligament intact group(n=71,including 49 males and 22 females).Intercondylar notch width,intercondylar notch height,bicondyle width,notch width index,angle of intercondylar notch,Blumensaat's line inlication angle,medial tibial spine height,lateral tibial spine height,tibial spine width,tibiofemoral consistency index,tibial plateau anterior-posterior diameter,medial tibial depth and patellar tendon-tibial shaft angle were measured on MRI images.Posterior tibial slope was measured on X-ray images.The above indicators were included in the logistic regression analysis for investigation. RESULTS AND CONCLUSION:(1)Univariate logistic regression analysis in men showed that tibial spine width,tibiofemoral consistency index,medial tibial depth,and posterior tibial slope were associated with posterior cruciate ligament injury(P<0.05).Multivariate binary logistic regression analysis showed that tibiofemoral consistency index and medial tibial depth were associated with posterior cruciate ligament damage(P<0.05).(2)Univariate logistic regression analysis in women showed that medial tibial spine height,lateral tibial spine height,tibial spine width,and posterior tibial slope were associated with posterior cruciate ligament injury(P<0.05).Multivariate binary logistic regression analysis showed that posterior tibial slope was associated with posterior cruciate ligament damage(P<0.05).(3)The receiver operating characteristic curve showed that tibiofemoral consistency index,medial tibial depth and posterior tibial slope had a certain predictive value on posterior cruciate ligament damage.(4)These findings suggest that anatomical morphological risk factors for posterior cruciate ligament injury differ between men and women,and tibial spine width and posterior tibial slope are common risk factors.In the male population,abnormal tibial spine width,tibiofemoral consistency index,medial tibial depth,and posterior tibial slope are easy to induce posterior cruciate ligament injury.In the female population,abnormal medial tibial spine height,lateral tibial spine height,tibial spine width,and posterior tibial slope are easy to induce posterior cruciate ligament injury.Clinicians can use the above risk factors to identify abnormal knee morphology,assess people at risk of posterior cruciate ligament injury,and provide preventive advice and guidance for treatment.

In order to deeply learn the circuit principle and typical fault analysis methods of medical electric bed,motivate and improve the independent maintenance ability of medical engineers,the functions and structures of commonly used medical multi-function electric beds were introduced.Based on the control circuit boards of 3 brands of medical multifunctional electric bed used in Nanjing BenQ Hospital,the electrical schematic diagram was drawn,the working principle was analyzed,the common faults were analyzed,and the causes and solutions of the faults were found,so as to ensure the normal operation of various brands of electric beds in the hospital,effectively control the maintenance cost,and improve the maintenance efficiency and service level.

Objective:To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection ( treatment excluded) (hereinafter referred to as sixth national consensus) and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment (hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan. Methods:From February 20 to May 7, 2023, a questionnaire survey on the diagnosis and treatment of Helicobacter pylori ( H. pylori) infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province. The questionnaire was drawn up according to the sixth national consensus and the guideline, covering knowledge of 6 sections, induding H. pylori related diseases, detection of H. pylori, eradication, prevention and influence factors of eradication of H. pylori, etc. Chi-square test was used for statistical analysis. Results:A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00%.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments, 264 surgeons and 471 medical technologists and pharmacists). About 78.67%(177/225)of gastroenterologists agreed that the overall infection rate of H. pylori in China was more than 20%, the awareness rate was higher than that of other medical staff (physicians from other departments 65.41%(329/503), surgeons 61.74%(163/264), medical technologists and pharmacists 60.30%(284/471); the following datas were sorted by this position), and the difference was statistically significant ( χ2=30.97, P<0.001). About 51.11%(115/225) of gastroenterologists considered that H. pylori serological antibody test could not be used as a diagnostic method for current infection, the awareness rate was higher than that of other medical staff(22.07%(111/503), 14.02%(37/264), 12.31%(58/471)), and the difference was statistically significant( χ2 =152.66, P<0.001). Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks, and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test, and the awareness rates of gastroenterologists were higher than those of other medical staff (38.67%(87/225) vs. 23.26%(117/503), 19.70%(52/264), 18.47%(87/471); 60.89%(137/225) vs. 26.64%(134/503), 25.76%(68/264), 23.78%(112/471)), and the differences were statistically significant ( χ2 =133.70 and 165.51, both P<0.001). For refractory H. pylori infection, 98.67%(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H. pylori infection should be guided by bacterial culture, antibiotic susceptibility test or drug resistance gene test, and the awareness rate was higher than that of other medical staff (91.85%(462/503), 93.56%(247/264), 93.21%(439/471)), and the difference was statistically significant( χ2=20.55, P=0.002). About 70.67% (159/225) of gastroenterologists recommended a bismuth containing quadruple regimen, 80.44% (181/225) supported a 10 to 14 day H. pylori eradication course, and the awareness rates were higher than other medical staff (46.92%(236/503), 33.33%(88/264), 32.91%(155/471); 67.20%(338/503), 59.09%(156/264), 53.93%(254/471)), and the differences were statistically significant ( χ2=111.25 and 59.99, both P<0.001). The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33% (192/225), which was higher than that of other medical staff (64.21%(323/503), 66.67%(176/264), 57.96%(273/471)), and the difference was statistically significant ( χ2=85.47, P<0.001). Conclusions:Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff. However, there is still a lack of deep understanding of the sixth national consensus and the guideline, and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.

Succinate dehydrogenase (SDH) defective renal cell carcinoma (RCC) is a new subtype of renal carcinoma newly identified by WHO(2016). Until now, only a few samples and a few cases have been reported retrospectively. This article reported a young female patient who was found to have a small tumor in the left kidney by physical examination and underwent left partial nephrectomy. The postoperative pathological result was SDH-RCC. There was no recurrence and metastasis of the tumor 3 months after operation.

The tiered medical treatment system stands as a cornerstone in the deepening reforms of China′s medical and health sectors, playing a crucial role in building a healthy China. Exploring the harmonious coexistence mechanism of multiple entities on the supply and demand sides of the tiered diagnosis and treatment system, and promoting the formation of a scientific and reasonable tiered diagnosis and treatment order, has become an urgent public proposition that needs to be answered and has significant social impact. Addressing the challenges in China′s tiered medical treatment system, particularly its need for a more systematic, comprehensive, and collaborative approach, this study is informed by a thorough literature review. Based on the harmonious management and symbiosis theories, the authors proposed a theoretical concept and future research path for the formation of a harmonious symbiotic mechanism in the tiered diagnosis and treatment system, in order to pave the way for exploring the harmonious symbiotic mechanism in the tiered diagnosis and treatment system.

OBJECTIVE To prepare Angelica•Cinnamomum（Angelica sinensis-Cinnamomum cassia ）self•microemulsion drug delivery system （AC•SMEDDS），and to optimize its formulation and characterize its preparation . METHODS Using Angelica• Cinnamomum mixed volatile oil as oil phase and model drug ，on the basis of selecting emulsifier and co -emulsifier and the optimization of their mass ratio range ，the formulation was optimized with central composite design •response surface methodology using the ratio of oil phase （Angelica•Cinnamomum mixed volatile oil ），mass ratio of emulsifier and co -emulsifier as factors ，the comprehensive score of volatile oil content ，particle size and emulsifying time as index . Morphology，particle size ，drug loading ， entrapped efficiency and stability of optimized AC•SMEDDS were characterized . RESULTS The optimum formulation of AC•SMEDDS contained the ratio of oil phase was 30%，and the mass ratio of emulsifier （EL•40）and co -emulsifier（ethanol）was 9∶1. Results of validation tests showed that the average particle size of AC•SMEDDS was （148.33±1.53）nm，and emulsifying time was （18.44±0.11）s. The comprehensive score was 0.68，relative deviation of which from the predicted value （0.70）was 2.86%. AC•SMEDDS prepared by optimal formulation was faint yellow ，uniform and transparent liquid ，and spherical particals with translucent edge were observed under transmission electron microscope . Calculated by ligustilide and cinnamaldehyde ，the drug loading was （7.58±0.03） and （4.17±0.01） mg/g，and entrapped efficiency was （93.25±0.01）% and （88.89±0.02）% ， respectively. No stratification or precipitation occurred after centrifugation at the speed of 10 000 r/min or placing within 7 （No.2019-0520） days at 4 and 25 ℃ . The contents of ligustilide and cinnamaldehyde were stable . Its particle size had no significant change after 50，100 and 200 times dilution by purified water . CONCLUTIONS AC•SMEDDS is prepared successfully and its formulation is optimized . The stability of the preparation is good .

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Objective:To investigate characteristics of fever and drug-induced liver injury (DILI) in inpatients with severe drug eruptions.Methods:A retrospective analysis was carried out on clinical data collected from 63 inpatients with severe drug eruptions from June 2007 to June 2020, and their characteristics of fever and DILI were investigated. Two-independent-sample t test or Kruskal-Wallis H test was used for intergroup comparison of measurement data, and intergroup comparison of enumeration data was performed using chi-square test or Fisher′s exact test. Results:Among the 63 patients with severe drug eruptions, 54 developed fever; low, moderate and high/ultra-high fever all occurred in about one third of the patients; of 17 patients with high/ultra-high fever, 16 sufferred from Stevens-Johnson syndrome (SJS) , toxic epidermal necrolysis (TEN) or drug hypersensitivity syndrome (DHS) ; 45 had irregular fever; fever duration ranged from 1 to 14 days in 51 patients; there were no significant differences in the fever grade or duration among the patients with different clinical types of drug eruptions ( P = 0.303, 0.719, respectively) ; rashes occurred earlier than or at the same time as fever in 92.59% of the patients. DILI occurred in 11 patients, 8 of whom had hepatocellular injury at admission, including 5 with DHS, 2 with SJS and 1 with TEN; 6 patients were accompanied by low, moderate or high fever, with the fever duration being 7.33 ± 4.97 days, and they all had grade 1 liver injury; liver function retesting at discharge showed complete recovery in 5 patients, improvement in 1, as well as conversion from hepatocellular injury to mixed liver injury in 1, and 1 patient did not undergo the liver function retesting due to against-medical-advice discharge. The other 3 patients had cholestatic liver injury, all of whom were diagnosed with DHS and accompanied by high or ultra-high fever, wtih the fever duration being 8.33 ± 3.51 days, and 1 patient had grade 4 liver injury (acute liver failure) ; liver function was improved in all the 3 patients at discharge. Conclusions:Patients with severe drug eruptions are prone to be accompanied by various types of fever, irregular fever is more common, fever usually lasts 2 weeks, and rashes often occur earlier than or at the same time as fever. DILI can occur in patients with severe drug eruptions, and is usually accompanied by fever; hepatocellular injury is more common, and prone to be improved rapidly; cholestatic liver injury is characterized by severe clinical symptoms and a long disease course, and most frequently occurs in patients with DHS.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To analyze the safety and effectiveness of application of modified double-lumen microcatheter in the measurement of fractional flow reserve(FFR) in coronary bifurcation lesions.Methods:Total of 28 patients with coronary bifurcation lesions in two centers were divided into two groups:conventional technique group(CON) and novel technique group(NOV). The fluoroscopy time, contrast dye usage and FFR-related complications of the two groups were analyzed retrospectively.Results:There were 16 cases in CON group and 12 cases in NOV group. The median time required fluoroscopy in NOV group was significantly less than that in CON group; additionally, lesser amounts of contrast dye were used in NOV group (both P<0.05). The NOV group procedures were successfully accomplished in all cases without complications, such as damage of the pressure sensor, SB spasm or dissection. However, The CON group failed in three patients, including two who experienced coronary artery spasms( P>0.05). Conclusions:Limited experience suggests that the application of modified double-lumen microcatheter in the jailed SB FFR measurement after MV stenting is a safe and technically feasible approach.