Objective:To analyze the efficacy of anterior cervical Hybrid surgery and posterior cervical expansive open-door laminoplasty(EODL)in the treatment of multilevel cervical spondylotic myelopathy,and to discuss the selection of surgical methods for the patients with multilevel cervical spondylotic myelopathy.Methods:The retrospective analysis was conducted of 70 patients with multilevel cervical spondylotic myelopathy who underwent surgery at Affilated Beijing Traditional Chinese Medicine Hospital of Capital Medical University from July 2017 to July 2020.Based on the different surgical methods,the patients were divided into anterior group(n=35)and posterior group(n=35).The patients in anterior group underwent Hybrid surgery[anterior cervical discectomy and fusion(ACDF)combined with artificial cervical disc replacement(ACDR)],and the patients in posterior group underwent EODL.The hospitalization time,operation time,intraoperative blood loss,and postoperative drainage volume of the patients in two groups were recorded;the efficacy was evaluated by Japanese orthopaedic association(JOA)score,JOA improvement rate,neck disability index(NDI),visual analogue scale(VAS)for pain,and postoperative satisfaction score;the complications of the patients in two groups after surgery were recorded.Results:Compared with posterior group,the intraoperative blood loss,postoperative drainage volume,hospitalization time,and operation time of the patients in anterior group were significantly decreased(P<0.01),and the preoperative score had no significant difference(P>0.05).At the final follow-up after surgery,compared with posterior group,the JOA score and JOA improvement rate of the patients in anterior group were significantly increased(P<0.01),and the NDI score and VAS score were significantly decreased(P<0.01).Compared with before surgery,the JOA scores of the patients in two groups at the final follow-up after surgery were increased(P<0.01),and the NDI and VAS scores were significant decreased(P<0.01).The postoperative satisfaction of the patients in two groups was high based on the postoperative satisfaction score.There was no significant difference in the incidence of postoperative complication of the patients between two groups(P>0.05).Conclusion:Both the anterior cervical Hybrid surgery and EODL achieve the satisfactory results in the treatment of multilevel cervical spondylotic myelopathy.Hybrid surgery has the advantages of less bleeding and shorter surgery time,and the most suitable surgical method should be chosen clinically based on the actual situation of the patients.

Objective:This study evaluates the performance of chemiluminescence assay, which is designed to detect Hepatitis D Virus (HDV) Immunoglobulin G (IgG) antibodies.Methods:A comparative analysis was conducted among chemiluminescence anti-HDV IgG reagent, the magnetic particle-based domestic reagent A and domestic reagent B, and the Robo Gene HDV RNA kit, using 1909 HBsAg-positive plasma samples. This comparison aimed to delineate clinical specificity and detection accuracy. The anti-HDV IgG reagent precision was assessed at three different concentration levels following the Clinical Laboratory Standards Institute EP5-A2 guidelines. The specificity of the assay was validated using 200 HAV IgM positive, 545 HBsAg-positive but anti-HDV IgG-negative, 350 anti HCV positive plasma samples and 200 healthy human blood samples. Additionally, a concordance study was conducted with 545 HBsAg-positive and 37 anti-HDV IgG-positive plasma samples, comparing the anti-HDV IgG reagent against reagent A.Results:1 909 HBsAg-positive plasma samples were tested using 3 anti HDV IgG reagent and 1 HDV RNA reagent, 19 samples were identified as anti-HDV IgG-positive. The anti-HDV IgG demonstrated superior accuracy and specificity. The assay exhibited excellent precision, with intra-assay coefficient of variation (CV) values ranging from 1.57% to 4.30%, and inter-assay CV values between 1.71% and 4.67% for detecting samples at high, medium, and low concentration levels. Concordance with Reagent A showed consistent results in both positive and negative detections.Conclusion:In this study, the anti-HDV IgG reagent (chemiluminescence method) displayed outstanding specificity in detecting clinical samples and exhibited a high conformity rate with commercialized reagents, making it potentially suitable for screening anti-HDV IgG in HBsAg-positive samples.

Objective:This study aims to evaluate the quality and explore the preliminary clinical applications of a domestically developed hepatitis D virus nucleic acid quantification reagent (abbreviated as"domestic HDV RNA reagent").Methods:The sensitivity and accuracy of the reagent were evaluated in accordance with the WHO HDV RNA international standard, employing the Bio-Rad CFX Opus 96 real-time fluorescence quantitative PCR analysis system. Serial dilutions of pseudo-viruses or cell culture-derived virus were used to determine the linear range of the domestic HDV RNA reagent. Specificity was assessed using positive samples of HAV, HBV, HCV infection, and HEV national reference materials. Precision was evaluated with samples at both high and low concentrations. In a comparative analysis, 30 HDV IgG positive samples were tested using both the domestic HDV RNA reagent and the RoboGene HDV RNA kit based on the ABI 7500 FAST DX system. The Pearson correlation coefficient (r) was used to examine the correlation between the two reagents.Results:The domestic HDV RNA reagent demonstrated a high sensitivity of up to 6 IU/ml, consistent with that of the comparator reagent. The calibration curve for WHO HDV RNA standards had a slope of -3.286, with an amplification efficiency of 101.6%. The linear detection range spanned from 10 to 10 8 IU/ml for eight HDV genotypes. The domestic HDV RNA reagent exhibited exceptional specificity, without cross-reactivity observed with HAV, HBV, HCV, or HEV. Accuracy assessments at five concentration levels met the required standards, with intra-assay precision coefficient of variation ( CV) ranging from 1.20% to 4.20%, and inter-assay precision CV from 1.20% to 7.90%. The detection results for HDV IgG positive samples were highly correlated with the comparator reagent ( r=0.984, P<0.001), achieving a diagnostic accuracy of 100% compared to sequencing results. Conclusion:In this study, the domestic HDV RNA reagent possesses excellent specificity, accuracy, precision, and a broad linear range, attaining a sensitivity level on par with international reagents of the same type.

ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

Objective:To compare the effect and clinical significance of unilateral and bilateral percutaneous kyphoplasty (PKP) combined with hyperextension reduction in the treatment of fresh osteoporotic vertebral compression fracture (OVCF).Methods:The clinical data of OVCF patients treated in Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January to December 2018 were retrospectively analyzed.A total of 62 patients were included.According to the surgical approach, 62 patients were divided into unilateral puncture approach group and bilateral puncture approach group, with 31 cases in each group.The patients in the unilateral puncture group were treated with limb hyperextension reduction combined with unilateral PKP.In the bilateral puncture approach group, limb hyperextension reduction combined with bilateral PKP was used.The changes of visual analogue pain scale (VAS), Oswestry disability index (ODI), vertebral anterior height, vertebral midline height and Cobb angle were observed and compared before operation, 1 day and 2 weeks after operation.At the same time, the operation time, intraoperative fluoroscopy times, intraoperative bone cement injection and adverse reactions were compared between the two groups.Results:The VAS scores of patients in the unilateral puncture approach group before operation, 1 day and 2 weeks after operation were (8.10±0.17), (2.20±0.26) and (1.90±0.39), respectively.The scores of bilateral puncture approach group were (8.10±0.13), (2.30±0.26) and (2.00±0.30), respectively.The results of repeated measurement ANOVA showed that F intra-group=13 790.444, P<0.001, F inter-group=1.951, P=0.168, F interaction=0.735, P=0.481.There were significant differences in VAS scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in VAS score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The ODI scores of patients in the unilateral puncture group before operation, 1 day and 2 weeks after operation were (40.30±5.30), (23.20±3.40), (22.30±4.49) points respectively, and those in the bilateral puncture group were (41.00±4.49), (21.90±2.48), (20.70±5.70) points, respectively.The results of repeated measurement ANOVA showed that F intra-group=339.046, P<0.001, F inter-group=1.385, P=0.244, F interaction=1.083, P=0.342.There were significant differences in ODI scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in ODI score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The anterior height of vertebral body in unilateral puncture group was (18.26±2.40), (21.97±1.17), (22.03±1.35) mm before operation, 1 day and 2 weeks after operation, and that in bilateral puncture group was (18.94±1.80), (22.06±2.79), (20.29±1.19) mm.The results of repeated measurement ANOVA showed that F intra-group=51.228, P<0.001, F inter-group=1.594, P=0.212, F interaction=6.452, P=0.002.There were significant differences in the anterior vertebral height between the two groups 1 day and 2 weeks after operation (all P<0.05). The height of vertebral midline in the unilateral puncture group was (17.97±2.14), (26.13±1.43), (26.00±1.79) mm before operation, 1 day and 2 weeks after operation, and in the bilateral puncture group was (18.84±1.77), (24.74±1.77), (24.68±2.06) mm.The results of repeated measurement ANOVA showed that F intra-group=358.837, P<0.001, F inter-group=3.850, P=0.054, F interaction=9.117, P<0.001.There were significant differences in the height of vertebral midline between the two groups 1 day and 2 weeks after operation (all P<0.05). The Cobb angles in the unilateral puncture group were (21.74±2.11)°, (11.77±1.91)° and (10.94±1.12)° before operation, 1 day and 2 weeks after operation, respectively, and in the bilateral puncture group were (22.13±2.50)° and (12.0±2.38)° and (11.71±1.37°, respectively.The results of repeated measurement ANOVA showed that F intra-group=674.732, P<0.001, F inter-group=1.975, P=0.165, F interaction=0.376, P=0.688.There were significant differences in Cobb angle between the two groups 1 day and 2 weeks after operation (all P<0.05). There were significant differences in operation time ((52.0±3.8) min and (67.0±6.7) min), intraoperative fluoroscopy times ((15.0±5.8) times and (32.0±6.1) times), and bone cement injection volume ((4.6±0.3) mL and (5.0±0.1) mL) between unilateral puncture approach group and bilateral puncture approach group (all P<0.001). Conclusion:Unilateral and bilateral PKP combined with hyperextension reduction can alleviate the pain of OVCF, restore the lost vertebral height and correct kyphosis.The unilateral puncture approach PKP combined with hyperextension reduction has the advantages of shorter operation time, concise operation process, fewer times of intraoperative fluoroscopy and less use of bone cement.

The distribution of peripheral blood lymphocyte subsets were compared between patients with colorectal cancer and healthy controls.The number of natural killer(NK) cells and CD8+T cells and the percentage of naive CD4+T cells were all decreased significantly in patients.On the contrary,the percentages of memory CD4+T cells,HLA-DR+ CD8+ T cells and CD38+ CD8+ T cells were significantly increased.It suggests that the tumor killing effect of cytotoxic lymphocytes in peripheral blood is impaired in patients with colorectal cancer,whereas the immune response is over stimulated.

OBJECTIVETo explore the efficacy of video-assisted anal fistula treatment (VAAFT) in treatment of complex anal fistula.

METHODSClinical data of 87 patients with complex anal fistula undergoing operation at Department of General Surgery, the Second Affiliated Hospital of Suzhou University from September 2015 to December 2016 were collected to conduct a cohort study. The operative procedure depended on economic conditions and patient preference. Patients were divided into VAAFT group (42 cases) and traditional fistula resection plus seton (FRS) group (45 cases). The procedure of FRS was to completely remove the fistula along external wall, the inner opening and surrounding scar tissues, then, the inner opening was closed with absorbable suture. For deeper and more complex fistula, the above procedure should be combined with seton. Based on the concept of endoscopic minimally invasive surgery, VAAFT could deal with the fistula and inner opening under direct vision. The brief steps were as follows: insertion of the anal fistula scope through external opening into the fistula; continuous injection of glycine-mannitol solution to expand and clean the foul fistula; electrocoagulation of all lesions; clearance of burnt tissues from the lumen with endoscopic brush and forceps; injection of medical fibrin glue through the inner opening; closing the inner opening by suture. Intraoperative and postoperative indices were compared between two groups.

RESULTSVAAFT group included 33 males and 9 females with mean age of (37.4±13.5) years, mean BMI of (24.3±3.2) kg/m, and mean disease course of (4.8±3.9) months. Of 42 cases, 5 had preoperative diabetes mellitus, 31 were high fistula and 11 were low fistula. FRS group included 32 males and 13 females with mean age of (42.1±15.6) years, mean BMI of (24.8±3.7) kg/m, and mean disease course of (5.7±3.6) months. Of 45 cases, 4 had preoperative diabetes mellitus, 37 were high fistula and 8 were low fistula. There were no significant differences in baseline data between two groups(all P>0.05). Compared with FRS group, VAAFT group had significantly shorter operative time [(44.6±10.5) minutes vs. (57.4±12.3) minutes, t=5.203, P=0.000], lower incidence of postoperative bleeding (14.3% vs. 33.3%,χ²=4.304, P=0.038), less pain (Visual Analogue Scale,VAS) (2.9±1.8 vs. 7.3±1.2, t=13.500, P=0.000), faster pain relief [(1.0±0.8) days vs. (4.5±1.2) days, t=15.890, P=0.000] and shorter hospital stay [(4.1±3.5) days vs.(7.5±2.3) days, t=5.389, P=0.000]. However, there were no significant differences between two groups in urinary retention rate, first postoperative fecal time and postoperative infection rate(all P>0.05). All patients were followed up for more than 6 months, FRS group had significantly higher incidence of anal incontinence than VAAFT group (20.0% vs. 2.4%, Fisher P=0.015). However, no significant difference in recurrence rate was found between VAAFT and FRS group(7.1% vs. 15.6%, Fisher P=0.317).

CONCLUSIONSCompared to traditional FRS treatment, VAAFT possesses some advantages in less injury, less pain, faster recovery, and lower postoperative anal incontinence rate. Thus, VAAFT is a superior operative choice in treatment of patients with complex anal fistula.

Adult ; Cohort Studies ; Fecal Incontinence ; Female ; Humans ; Male ; Middle Aged ; Rectal Fistula ; surgery ; Treatment Outcome ; Video-Assisted Surgery ; Young Adult

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.

Objective To analyze the magnetic resonance imaging (MRI)and histologic features of the synchronous bilateral primary breast cancer (sBPBC).Methods MRI findings and pathologic types of sBPBC in 20 patients in our institute were reviewed retrospectively. The MRI features of sBPBC were compared with the pathologic types,respectively.Results 20 sBPBC patients with 41 lesions were found with the most common pathological type of invasive ductal carcinoma in 26 (26/41 ).Bilateral lesions had the same pathological types in 1 1 patients(1 1/20),and different types in 9(9/20).The MRI features of invasive breast cancer were more characteristic than that of early breast cancer.In 20 patients,the first and second primary breast cancers with similar MRI findings were found in 6(6/20).In 10 patients with sBPBC,the first cancer was advanced breast cancer,and the second was early or low grade breast cancer.Conclusion (1)The most common pathological type of sBPBC is invasive ductal carcinoma,and the pathological types of bilateral lesions are not similar. (2)The MRI features of the first and the second lesions in bilateral primary breast cancer showed lower similarity,and the bilateral lesions should be diagnosed independently.(3)In patients with sBPBC,some cancers are advanced breast cancers,and the second ones are early cancers,suggesting the lesion should be followed up if the contralateral one is diagnosed as breast cancer.

BACKGROUND:Percutaneous vertebraplasty is a new means for the treatment of vertebral compression fractures and bone metastases. The multiplaner reconstruction with digital substraction angiography (DSA)-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, which can effectively prevent the leakage of bone cement. OBJECTIVE:To explore the value of DSA-Innova 3D in the guidance of puncture of percutaneous vertebroplasty. METHODS:From March 2014 to September 2014, a total of 72 patients with 94 vertebras were selected for percutaneous vertebraplasty, of whom 36 (48 vertebras) with Innova 3D (experimentalgroup) and 36 (46 vertebras) without Innova 3D (control group). Spiral CT scan was performed in al patients to assess the distribution of bone cement. The imaging quality in the two groups was compared by Mann-Whitney U test. RESULTS AND CONCLUSION:CT showed bone cement leakage occurred in 7 of the 36 patients in the control group. Leakages were into the lumber disc in two cases, paravertebral space in two cases, vertebral pedicle in onecase or veins in two cases. However, only one case of bone cement leakage was observed in the experimental group. With the guidance of DSA-Innova 3D, the experimental group had signficantly lower leakage and fluoroscopic time than the control group (P < 0.05). The multiplaner reconstruction with DSA-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, thereby effectively reducing the leakage of bone cement.