AIM:To compare the efficacy and safety of early combination therapy with ranibizumab and dexamethasone intravitreal implants versus ranibizumab monotherapy for the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: A retrospective cohort study was conducted on a total of 62 cases(64 eyes)of patients who were first diagnosed with RVO-ME at the Eye Centre of the Affiliated Hospital of Shandong Second Medical University between February 2022 and February 2023. The subjects were divided into two groups according to the different treatment regimens: 32 cases(34 eyes)in the monotherapy group received only ranibizumab [3+pro re nata(PRN)regimen], and 30 cases(30 eyes)in the combination therapy group were injected with ranibizumab once first, followed by dexamethasone intravitreal implant 3 wk later(1+DEX regimen). The best corrected visual acuity(BCVA), central retina thickness(CRT), foveal avascular zone(FAZ)area, macular vascular density(MVD)at the level of the deep vascular complex(DVC)of the retina, the incidence of ocular adverse effects, the number of drug injections, and the total cost between the two groups were compared before and after treatment.RESULTS: At 3 wk, 3 and 6 mo, and at the final follow-up of the two groups of patients, the improvement in BCVA, CRT, and MVD in the DVC layer was significantly better than that before treatment(all P<0.05); there were differences in the comparisons of BCVA and CRT between the two groups at 6 mo and the final follow-up(all P<0.05), and the increase in the number of letters of BCVA was the most pronounced in the combination therapy group at 6 mo of treatment. Statistical significant difference was observed in the comparison of MVD in the DVC layer between the two groups at 3 and 6 mo after treatment and at the final follow-up(all P<0.05). However, no significant change in FAZ area was evident before and after treatment in both groups(P>0.05). The combination therapy group exhibited a reduced number of injections and total cost in comparison to the monotherapy group. The combination therapy group exhibited a slightly higher incidence of high intraocular pressure and cataract progression compared to the monotherapy group, with no statistical significant difference(all P>0.05). Furthermore, no serious adverse events were observed in either group following treatment.CONCLUSION:Compared with ranibizumab alone, ranibizumab combined with dexamethasone intravitreal implant significantly improved vision, reduced macular edema, and lowered the frequency of injections and total treatment cost in patients with RVO-ME. CRT and MVD in the DVC layer are reliable prognostic indicators for patients with RVO-ME.

To compare and analyze the "same disease, same price" policy in the regionsimplementing diagnosis related group(DRG) payment reform, and to provide recommendations for further policy optimization and extension.

Objective:To investigate the initial effectiveness of manual techniques versus navigation positioning system-assisted reconstruction for anterior cruciate ligament (ACL) injuries in children and adolescent populations.Methods:A retrospective analysis was conducted on 28 patients with ACL rupture who underwent primary total epiphyseal ACL reconstruction in the Sports Medicine Treatment Center of Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2019 to October 2022. Patients were categorized into two groups based on the method of guide needle insertion: the manual group (guide needle insertion relying on the operator's expertise) and the robot-assisted group (guide needle insertion assisted by the Tianji robot navigation and positioning system). The manual group comprised 14 cases (9 males, 5 females) with an average age of 13.59±1.59 years, while the robot-assisted group included 14 patients (10 males, 4 females) with an average age of 13.27±1.66 years. The operation time, intraoperative fluoroscopy times, guide needle placement times, the distance between the central point of the internal articular opening of the tibial and femoral bone tunnel and the ideal point, the rate of epiphyseal inflammation, and the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, KT-2000 ligament relaxation, lower limb force line were compared between the two groups.Results:The follow-up duration was 19.9±6.3 months for the manual group and 18.8±4.9 months for the robot group ( t=0.546, P=0.589). The manual group's operation duration was 123.0±12.6 min, significantly longer than the robot group's 96.4±12.9 min ( t=5.502, P<0.001). Intraoperative fluoroscopy was performed 11.8±3.1 times in the manual group, markedly more than the robot group's 3.7±0.8 times ( t=9.434, P<0.001). The robot group required only one guide needle placement for both femur and tibia, while the manual group had 5.7±1.2 placements on the femur side and 4.6±1.8 on the tibia side. The distance between the femoral joint's central point and the ideal point was 0.87±0.20 mm in the robot group, superior to the manual group's 1.92±0.64 mm ( t=5.816, P<0.001). Similarly, the distance between the central point and the ideal point was 1.15±0.34 mm for the robot group, better than the manual group's 1.94±0.55 mm ( t=4.582, P<0.001). No cases of epiphyseal irritation were observed in the robot group, while 21% (3/14) of the manual group experienced tibial or femoral epiphyseal plate involvement. At 3 months post-surgery, the robot group exhibited higher IKDC subjective scores (90.57±8.46) and Lysholm scores (86.29±5.09) compared to the manual group (83.50±6.19 and 80.93±5.93), respectively ( P<0.05). However, at the final follow-up, there were no significant differences in IKDC subjective scores, Lysholm scores, or KT-2000 ligament relaxation between the two groups ( P>0.05). Both groups showed normal lower limb force alignment and no abnormal growth or development. Conclusion:Tianji robot navigation and positioning system-assisted ACL reconstruction in children and adolescents offer advantages such as precise positioning, shorter operation times, reduced intraoperative fluoroscopy, faster recovery, and enhanced epiphyseal protection compared to manual methods.

Objective:To investigate the utilization of health management services and its influencing factors among new urban population.Methods:It is a cross-sectional study. From July 2020 to March 2021, a stratified random sampling method was used to extract 1978 new urban population in Jining city, and an anonymous self-administered questionnaire survey was conducted using a self-made questionnaire ′Residents Health Questionnaire′. The survey included general demographic characteristics, personal behavior lifestyle and medical care status. The χ2 test and binary logistic regression were used to analyze the factors influencing the utilization of health management services by new urban population. Results:The overall utilization of health management services in the new urban population was 47.22%. There were significant differences in utilization of health management services among new urban population with different gender, age, education level, occupation and monthly income. Binary logistic regression analysis showed that female ( OR=1.354, 95% CI: 1.094-1.676), people aged over 60 years ( OR=1.873, 95% CI: 1.413-2.483), people with a mean monthly income over 3 000 yuan ( OR=1.498, 95% CI: 1.123-1.997), people engaged in light manual labor ( OR=1.596, 95% CI: 1.003-2.539), people who exercise regularly( OR=2.400, 95% CI: 2.028-2.841) and people having social basic medical insurance ( OR=2.633, 95% CI: 2.042-3.394) had better utilization of health management projects. People who sat more than 3 hours a day ( OR=0.630, 95% CI: 0.532-0.745) had lower utilization of health management care. Conclusion:The utilization of health management projects in the new urban population is low. Gender, age, monthly income, physical exercise, sedentary time, daily labor intensity and social basic medical insurance status are the main influencing factors.

BACKGROUND: The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. METHODS: Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. RESULTS: In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. CONCLUSIONS Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
Humans ; Arthritis, Psoriatic/drug therapy* ; East Asian People ; Enthesopathy/complications* ; Registries ; Severity of Illness Index ; Spondylarthritis/epidemiology*

Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.

This article reports a case, happened in July 2019, of 9 severed segments of 2nd-5th fingers in left hand treated in the Department of Repair and Microsurgery, Zhengzhou Renji Hospital. Through the unified management before surgery, team surgery, three or four fixed-point mattress eversion suture and close observation after surgery. It can effectively prevent the occurrence of vascular compromise. All the replanted fingers survived after the surgery. And the function of the fingers recovered well at 2 years after surgery through early and continuous rehabilitation exercise.

Objective:In Shanghai Advanced Proton Therapy Facility (SAPT) of Ruijin Hospital Proton Therapy Center, the calculation accuracy of the commercial proton treatment planning system RayStation (V10), especially the accuracy of the proton range calculation, was measured and verified, aiming to provide reference for the clinical application of the treatment planning system.Methods:A head phantom was used to verify the calculation accuracy of RayStation. The phantom CT was imported into treatment planning system (TPS). The phantom was followed closely by a water tank with a one-liter cubic target. A single field verification plan with the prescribed dose of 200 cGy (relative biological effectiveness) was designed and implemented. Then, the measured distribution results were compared with the calculation results.Results:When the verification plan of the phantom was designed with the default settings of RayStation, the measured longitudinal dose distribution was approximately 4 mm deeper than that of TPS, indicating that RayStation overestimated the water equivalent thickness (WET) of the tissue substitute materials in the phantom. To study the range error, the actual beam was used to measure the WET of the soft tissue substitute material. The default setting of RayStation was fine-tuned according to the measured results. It was found that the error between the measured SOBP and TPS calculations was reduced to only 2 mm.Conclusions:Using the default setting of RayStation to calculate the stopping power of the phantom may cause a large range error. A method that combines tissue segmentation with the measured WET of the tissue substitute material is proposed to improve the range calculation accuracy of the TPS. The results show that the proposed method can improve the dose and range accuracy of the commercial TPS including RayStation for tissue substitute materials.

Objective:To observe the clinical efficacy of ultrasound cycloplasty (UCP) in the treatment of uncontrolled intraocular pressure (IOP) after glaucoma surgery.Methods:An observational case series study was carried out.Twenty-eight consecutive patients (28 eyes) with uncontrolled IOP after glaucoma surgery who received UCP treatment in The First Affiliated Hospital of Zhengzhou University from July 2018 to October 2019 were enrolled.The IOP of these patients was ≥21 mmHg (1 mmHg=0.133 kPa) under the maximum tolerated dose.According to preoperative IOP and visual acuity, the patients were divided into 8-sector group (17 eyes) and 10-sector group (11 eyes). The duration of UCP operation, preoperative and postoperative 1-day, 1-week, 2-week, 1-month and 3-month IOP and BCVA, the types of drugs for lowering IOP preoperatively and postoperatively, preoperative and postoperative 3-month ocular pain grading and corneal endothelial cell counts, and adverse reactions during the operation and after surgery were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2020-KY-154). Written informed consent was obtained from each subject prior to any medical examination.Results:The duration of UCP operation was 3 to 7 minutes, with an average of (4.30±1.26) minutes.The IOP at 1 day, 1 week, 2 weeks, 1 month and 3 months after operation was (32.96±10.49), (25.89±7.25), (24.50±6.23), (24.07±6.59), (24.32±6.52)mmHg, respectively, which were significantly lower than (45.82±8.81) mmHg before operation (all at P<0.05). There was no significant difference in IOP between the 8-sector group and 10-sector group ( Fgroup=1.271, P=0.270), but there was a significant difference in IOP between the two groups before and after operation ( Ftime=54.388, P<0.01), and the postoperative IOP at various time points in the two groups were lower than the preoperative IOP, showing statistical significances (all at P<0.05). There was no significant difference in BCVA before and after surgery ( F=2.562, P=0.075). There was a statistically significant difference in BCVA between the 8-sector group and 10-sector group ( Fgroup=12.602, P=0.001), but no statistically significant difference was found in BCVA between the two groups before and after surgery ( Ftime=1.701, P=0.139), and the BCVA in the 8-sector group was better than the 10-sector group at various time points (all at P<0.05). The types of IOP lowering drugs used in the 8-sector group and 10-sector group were 3 (2, 3) and 3 (2, 4) before operation respectively, and 0 (0, 1) and 0 (0, 0) at 3 months after operation respectively.The preoperative ocular pain grade was 2 (2, 2), and the postoperative 3-month ocular pain grade was reduced to 1 (0, 1), and the difference was statistically significant ( Z=-4.824, P<0.05). The postoperative 3-month pain grading in the 8-sector and 10-sector groups were significantly lower than the preoperative pain grading ( Z=-3.739, -3.127; both at P<0.05). The corneal endothelial cell count was significantly decreased from (1 967.15±186.06) cells/mm 2 before operation to (1 861.08±206.63) cells/mm 2 at 3 months after operation ( t=2.781, P=0.017). No serious complications occured during the operation.Postoperative adverse reactions included chemosis and bulbar hyperemia, corneal edema, headache, ocular pain, anterior chamber inflammation, etc.Serious complications such as low IOP, macular edema, vision loss or eyeball atrophy were not observed. Conclusions:UCP has no surgical incision.Treatment of both 8 sectors and 10 sectors can effectively reduce IOP, reduce the types of IOP lowering drugs, and relieve ocular pain in patients with uncontrolled IOP after glaucoma surgery with few intraoperative and postoperative adverse reactions.

OBJECTIVE：To systematically review the efficacy of tamsul osin a lone or combined with antimuscarinic drugs in the treatment of ureteral stent-related symptom （SRSs），and to provide evidence-based reference for the clinical treatment. METHODS：Retrieved from PubMed ，Embase，Cochrane Library ，CJFD，CBM，VIP and Wanfang database ，from the inception to Oct. 2019，RCTs about tamsulosin alone （monotherapy group ）or combined with antimuscarinic drugs （combination group ） versus placebo or blank control （control group ）in the treatment of SRSs were collected. After data extraction of included clinical studies met inclusion criteria ，their quality was evaluated with Cochrane collaborative network system evaluation manual 5.1.0，and Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS ：A total of 9 RCTs were included ，involving 932 patients. Meta-analysis results showed that after stent placement ，the urinary symptoms score [MD ＝－4.23，95％CI（－5.96， －2.51），P＜0.000 01]，body pain score [MD ＝－4.20，95％CI（－5.30，－3.10），P＜0.000 01]，general health score [MD ＝ － 1.36， 95％ CI（ － 1.75， － 0.98）， P＜0.000 01] in monotherapy group were significantly lower than control group with statistical significance ； there was no significantly 2805097532@qq.com difference in the work performance score [MD ＝0.19，95％CI（－0.99，1.37），P＝0.76]，sexual matters score [MD ＝－0.31 95％CI（－0.68，0.05），P＝0.09] in 2 groups. 4 weeks after the stent was removed ，the body pain score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01]，general health score [MD ＝ －0.28，95％CI（－0.41，－0.15），P＜0.000 01] ，urinary symptoms score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01] in monotherapy group were significantly lower than control group after stent placement ，with statistical significance ；there was no significantly difference in the work performance score [MD ＝0.31，95％CI（－0.22，0.84），P＝0.25] or sexual matters score [MD ＝ －0.31，95％CI＝（－0.68，0.05），P＝0.09] in 2 groups. The urinary symptoms score [MD ＝5.93，95％CI（2.83，9.02），P＝0.000 2]， body pain score [MD ＝3.49，95％CI（1.39，5.60），P＝0.001] and general health score [MD ＝2.96，95％CI（1.44，4.49），P＝0.000 1] in the monotherapy group were higher than the combination group ；there was no significantly difference in the work performance score [MD ＝1.53，95％CI（－0.12，3.18），P＝0.07] or sexual matters score [MD ＝0.46，95％CI（－1.03，1.96），P＝0.54] in 2 groups. CONCLUSIONS：Tamsulosin has a good therapeutic effect on SRSs ；its combination with antimuscarinic drugs can achieve better therapeutic efficacty.