Objective:To retrieve, evaluate, and integrate the best evidence for the management of neurogenic bowel dysfunction (NBD) in spinal cord injury patients both domestically and internationally, providing a basis for relevant evidence-based practices.Methods:The guidelines, expert consensus, clinical decision-making, and systematic review of NBD management for spinal cord injury patients were electronically searched in various databases and professional association websites at home and abroad. The search period was from database establishment to March 31, 2023.Results:A total of 13 articles were included, including five guidelines, five evidence summaries, two expert consensus, and one clinical decision-making. A total of 33 recommendations for NBD management in spinal cord injury patients were summarized from five aspects of medical history assessment, medication management, physical therapy, diet and exercise, and health education.Conclusions:The best evidence for NBD management in spinal cord injury patients summarized is scientific and practical. Medical and nursing staff should selectively apply the best evidence based on clinical practice.

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation

【Objective】 To explore the difference of demographics and influencing factors of motivations between whole blood donors and plasmapheresis donors, so as to provide scientific reference for effective recruitment strategy. 【Methods】 A total of 200 whole blood donors from Guangyuan Blood Center and 200 plasmapheresis donors from Jiange Plasmapheresis Station were selected in August 2021 for on-site questionnaire survey using the method of cross-sectional survey. Statistical analysis was performed by chi-square test, univariate and multivariate logistic regression. 【Results】 There were significant differences in gender, age, occupation, education level and annual family income between whole blood donors and plasmapheresis donors (P<0.05). Males accounted for a large proportion of whole blood donors(124/196, 63.3%), whereas females accounted for a large proportion of plasmapheresis donors(117/198, 59.1%). There was little difference in the number of whole blood donors in different age groups, while the age of plasmapheresis donors was concentrated in 40~59 years old (167/198, 84.3%). In terms of occupation, civil servants (including public institutions) accounted the highest proportion in whole blood donors (41/196, 20.9%), and farmers accounted the highest proportion (152/198, 76.8%) in plasmapheresis donors. The number of whole blood donors increased with the education level, and donors with college/university and above degree accounted the largest proportion (80/196, 40.8%). Plasmapheresis donors with junior middle school education and college/university and above accounted the largest and smallest proportion (49.5% vs 4.5%). The annual family income of whole blood donors ranged from 30 000 to 80 000 yuan accounted the largest proportion (109/196, 55.6%), and the annual family income of plasmapheresis donors less than 30 000 yuan accounted the largest proportion (132/198, 66.7%). 【Conclusion】 There were significant statistical differences in gender, age, education level, occupation and annual family income between whole blood and plasmapheresis donors. Therefore, targeted recruitment strategies should be formulated.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

OBJECTIVE To study the nephrotoxicity of the extracts from different parts o f Miao medicine Wikstroemia indica in healthy rats ，and to provide reference for the study of its toxicity mechanism and clinical drug use. METHODS Using 70％ ethanol as solvent ，total ethanol extract of W. indica was extracted with diacolation method. After dispersing the above extract with water，the fractions of corresponding fractions were obtained with petroleum ether ，ethyl acetate and n-butanol，and the rest was the extract of water fraction. SD rats were randomly divided into total ethanol extract group ，petroleum ether fraction group ，ethyl acetate fraction group ，n-butanol fraction group ，water fraction group and blank group ，with 12 rats in each group （half male and half female ）. The rats in the administration groups were given the corresponding dose of drug solution intragastrically （total ethanol extract 317.520 mg/kg，petroleum ether fraction 7.875 mg/kg，ethyl acetate fraction 78.435 mg/kg，n-butanol fraction 53.865 mg/kg and water fraction 76.545 mg/kg），once a day ，for conse- cutive 2 weeks，and then stopped taking drug for 2 weeks； rats in the blank group were given equal volume of 1.0％ . sodium carboxymethyl cellulose solution intragastrically. Duringthe experiment ，the general conditions of rats were observed. The samples of urine （on the 14th and 28th day ），serum and bilateral renal tissues （on the 15th and 29th day ）were taken respectively，the renal index was calculated ，the levels of @qq.com renal function indexes in serum and urine were detected ，and the pathomorphological changes of renal tissues were observed. RESULTS During administration ，compared with blank group ，the rats in the total ethanol extract group and ethyl acetate fraction group showed poisoning behavior and activity characteristics such as mental depression ，decreased activity and diet ，thin stool and decreased body mass. The mental state of the rats in the petroleum ether fraction group ，n-butanol fraction group and water fraction group were slightly worse than that in blank group，and slightly decreased activity and diet as well as thin stool ，and slowly increased body mass were found ；however，there was no significant difference in anal temperature in each group. After 2 weeks of administration ，the renal index in total ethanol extract group ，the serum levels of N-acetylglucosaminidase（NAG），urea nitrogen （BUN）and creatinine （Cr）in total ethanol extract group and ethyl acetate fraction group ，serum level of NAG in n-butanol fraction group and serum level of Cr in water fraction group ，as while as NAG levels in urine of rats in total ethanol extract group and petroleum ether fraction group ，NAG and urinary protein levels in urine of rats in ethyl acetate fraction group were increased significantly （P＜0.05 or P＜0.01）. In the pathomorphological observation ，renal tubules showed different degrees of unclear structure ，cell swelling and a few cell necrosis in the total ethanol extract group ，petroleum ether fraction group and ethyl acetate fraction group ，accompanying by glomerular pyknosis，renal tubular sclerosis and inflammatory cell infiltration ，compared with blank group. After drug withdrawal ，the mental state of rats in the administration groups were significantly improved ，the amount of activity and diet increased ，and the stool tended to be normal. Two weeks after drug withdrawal and recovery ，the levels of above indexes in serum and urine of rats in administration groups returned to be close to that in blank group （P＞0.05）；the glomerular structure of rats in each administration group gradually recovered clearly ，and cell swelling and inflammatory cell infiltration were rare in total ethanol extract group ， petroleum ether fraction group and ethyl acetate fraction group. CONCLUSIONS The total ethanol extract ，petroleum ether fraction and ethyl acetate fraction of Miao medicine W. indica have certain nephrotoxicity and reversibility. The toxic component may

Laparoscopic proximal gastrectomy (LPG) can be selected for the treatment of early upper gastric carcinoma, but gastroesophageal reflux after operation would seriously affect the quality of life of patients. Esophagogastric anastomosis with double flap technique is a digestive tract reconstruction method using the anastomosis between the esophagus and the anterior wall of the stomach. Compared with other digestive tract reconstruction methods, esophagogastric anastomosis with double flap technique can maintain the postoperative body mass of patients in good condition, improve the nutritional status and the long-term quality of life of patients. Esophagogastric anasto-mosis with double flap technique has good anti reflux effects and retain the possibility of endoscopic examination and treatment. By reviewing literatures at home and abroad, and combined with clinical experiences, the authors discuss current status and digestive tract reconstruction methods of LPG, and deeply investigate the application prospect of esophagogastric anastomosis with double flap technique.

OBJECTIVE To study the toxicity of the extract from Mi ao medicine Wikstroemia indica to zebrafish . METHODS Zebrafish embryo model was used as the object ，after exposure to W. indica extract （10，20，40 μg/mL），the number of spontaneous twitching within 1 min，heart rate within 10 s，the occurrence of malformation and death were detected and recorded . Zebrafish was used as the object ，after exposure to W. indica extract（10-100 μg/mL）for 24，48 and 72 h，and the median lethal concentration（LC50）of W. indica extract to zebrafish at different time points were calculated . After exposure to low ，medium and high concentration （27，37，51 μg/mL）of W. indica extract，the liver phenotype ，hepatocyte apoptosis and lipid deposition of zebrafish were observed ，and the activities of alanine aminotransferase （ALT），aspartate aminotransferase （AST）and lactate dehydrogenase（LDH）in liver tissue were detected . RESULTS Compared with blank group ，the number of spontaneous twitching ， malformation rate （except for 10 μg/mL group ）and mortality of embryos increased significantly in 10，20，40 μg/mL groups of W. indica extract，and the heart rate （except for 10，20 μg/mL group ）of embryos decreased significantly （P＜0.05）. LC50 of W. indica extract to zebrafish at 24，48 and 72 h were 39.850，28.300 and 21.490 μg/mL，respectively. After drug treatment ，the transparency of liver area of zebrafish in low ，medium and high concentration groups of W. indica extract reduced and their shape were enlarged；apoptosis and lipid deposition increased ；the activities of ALT ，AST and LDH in liver tissue were significantly increased （P＜0.05）. CONCLUSIONS Miao medicine W. indica extract had develop mental toxicity to zebrafish embryos and he patotoxicity to zebrafish .

Objective:To compare the clinical efficacy between femoral neck system (FNS) and inverted cannulated compression screws (ICCS) in the fixation of adult femoral neck fracture.Methods:The clinical data were retrospectively analyzed of the 119 patients with femoral neck fracture who had received FNS or ICCS internal fixation at Department of Traumatic Orthopedics, West China Hospital from September 2019 to June 2020. They were divided into 2 groups according to their internal fixation methods. In the FNS group of 62 patients, there were 38 males and 24 females, with an age of (54.0±13.0) years, and 13 cases of type Ⅱ, 34 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification; in the ICCS group of 57 patients, there were 42 males and 15 females, with an age of (53.2±11.3) years, and 9 cases of type Ⅱ, 33 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification. The operation time, intraoperative blood loss, fluoroscopy frequency, hospitalization time, fracture healing time, Harris hip score and incidence of complications were compared between the 2 groups.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up duration ( P>0.05). There were significant differences between the FNS and ICCS groups in fluoroscopy frequency [(8.8±2.9) times versus (15.6±3.4) times], operation time [(45.2±10.1) min versus (51.8±11.7) min], fracture healing time [(3.2±0.4) months versus (4.0±0.6) months], Harris hip score at the last follow-up [(91.8±4.4) points versus (84.6±3.3) points], and femoral neck shortening at the last follow-up, favoring the FNS group (all P<0.05). There were no significant differences in follow-up time, hospitalization time, intraoperative blood loss or incidence of complications between the 2 groups ( P>0.05). Conclusions:In the fixation of adult femoral neck fractures, compared with ICCS, FNS can significantly reduce fluoroscopy frequency, shorten fracture healing and operation time, reduce risk of femoral neck shortening and hospitalization time, and promote functional recovery of the hip.

Objective To analyze the clinical outcome of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures.Methods From June 2012 to February 2018,28 patients who underwent the definitive perineal urethrostomy for a complex anterior urethral stricture were retrospectively reviewed.The mean age of the patients was 62.3 (range 34 to 77) years and stricture etiology was lichen sclerosus in 46.4％ (13/28) of the cases,iatrogenic stricture after transurethral resection of the prostate in 35.7％ (10/28),failed hypospadias repair in 10.7％ (3/28),infection 3.6％ (1/28)and idiopathic etiology 3.6％ (1/28).The mean stricture length was 9.6 (range 4.5 to 16.0) cm and the stricture length ＜5 cm in 7.1％ (2/28) of the cases,5-10 cm in 35.7％ (10/28) and ＞ 10 cm in 57.1％ (16/28).0f28 patients 21 (75％) underwent prior urethral dilation,4 (14.3％) underwent direct vision internal urethrotomy (DVIU) and 17 (60.7％) underwent urethroplasty.Among the medical history of interest,hypertension was observed in 17 patients (60.7％),chronic ischemic heart disease in 11 patients (39.3％),diabetes mellitus in 9 patients (32.1％) and chronic obstructive pulmonary disease (COPD) in 9 patients (32.1％).All patients completed the perineal urethrostomy with inverted U-shaped perineal skin flap.The patient was placed in a normal lithotomy position and an inverted U-shaped perineal incision was made.We can get an inverted U-shaped perineal skin flap after dissecting along the bulbospongiosus muscle.The bulbar urethra was opened along the ventral surface and the margins of the spongiosum tissue were closed with perineal skin flap.We analyzed the clinical characteristics of the patients,the outcome of the technique and investigated the satisfaction rates of the patients by outpatient follow-up or telephone interview.Surgical success was defined as functional voiding without the need for further procedures.Results The perioperative complications included 3 cases of urinary tract infection,1 case of bleeding and 1 case of wound dehiscence.Mean follow-up length was 27.2 (range 6.0 to 64.0)months.Of 28 cases 26 (92.9％) were successful and the mean maximum urinary flow rate was 26.5 (range 17.0 to 40.0) ml/s.Postoperatively,2 cases of urethrostomy strictures were found in 2 months and 4 months,respectively.They required periodic outpatient dilation and the younger one was in the waiting list for revision of the perineostomy and the older one refused the revision.Of 28 patients 24 (85.7％) were satisfied with the results obtained with surgery,15 were very satisfied,9 cases satisfied and 4 cases dissatisfied.Conclusions The successful rate of the definitive perineal urethrostomy for the complex adult anterior urethral strictures was high and patients were satisfied with the outcome of the surgery.The definitive perineal urthrostomy is a well-tolerated treatment option for patients with complex anterior urethral strictures,especially for those aged and with extensive comorbidities.

Objective To observe the effect of tirofiban,aspirin and Clopidogrel Hydrogen triple antiplatelet in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention and the effect on the incidence of major adverse cardiac events.Methods a total of 60 patients with acute myocardial infarction(AMI)in our hospital from January 2015 to-2016 in December were enrolled in this study.All patients were treated with percutaneous coronary intervention(PCI).The patients were randomly divided into control group(n=30)and observation group(n=30).The control group using clopidogrel hydrogen treatment,observation group were treated with tirofiban,aspirin and Clopidogrel Hydrogen triple antiplatelet therapy,the incidence and clinical effects of the two groups of major adverse cardiac events.Results the two groups before treatment,the platelet aggregation rate and platelet count had no statistically significant difference; no significant observation group after treatment compared 30d platelet count difference; observation group 30d after treatment,the platelet aggregation rate was lower than the control group(P<0.05); the observation group after the treatment of 30d MA-ADP on platelet drug reaction the inhibition rate is lower than the control group(P<0.05); the observation group after treatment of AA drugs 30d platelet inhibition rate,the inhibition rate of ADP,higher than that of the control group(P<0.05); the observation group after treatment,the incidence of major adverse cardiac events was 13.33％,33.33％in the control group,two groups of major adverse cardiac events was statistically significant the difference(P<0.05).Conclusion The patients with acute myocardial infarction undergoing primary percutaneous coronary intervention after treatment with tirofiban,aspirin and chlorine Pigre triple antiplatelet ideal treatment effect,can reduce the incidence of major adverse cardiac events,it is worthy of popularization and application.