Objective:To explore the effects of workshops combined with problem-based learning (PBL) in clinical teaching of joint surgery.Methods:A total of 60 students who would participate in standardized residency training from September 2019 to June 2021 were randomly divided into traditional lecture-based learning (LBL) group, PBL group, and workshops combined with PBL group, with 20 students in each group. The effects were evaluated by theoretical knowledge and clinical skill assessment and anonymous teaching quality questionnaire surveys. SPSS 25.0 was used to perform the t test and chi-squared test. Results:The workshop+PBL group showed the highest theoretical knowledge score (86.40±9.76), clinical skill score (92.15±4.49), and total score (88.70±5.75), compared with the PBL group (78.45±10.40, 85.80±10.00, and 81.39±7.27, respectively) and the LBL group (80.10±6.77, 85.20±8.12, and 82.14±6.14, respectively). According to the teaching quality questionnaire surveys, the workshop+PBL group was significantly superior to the PBL and LBL groups in self-ability evaluation and the degree of satisfaction with teaching ( P<0.05). Conclusions:Workshops combined with PBL can effectively improve students' scores of theoretical knowledge and clinical skills, with better self-ability evaluation results and higher satisfaction with teaching, which is worthy of application and promotion in clinical teaching of joint surgery.

[Objective]To explore the connotation of neo-Confucianism in ZHU Danxi medicine.[Methods]Combining the research methods of medicine and philosophy,based on ZHU Danxi's medical writings and related knowledge of neo-Confucianism,the connotation of neo-Confucianism of Danxi medicine was discussed from three aspects:"cognition view""sports view""cultivation view".[Results]ZHU Danxi was influenced by the thought of"one principle and different justics"and regarded medicine as the way to practice Confucian ideal.Using the understanding method of"thinking phyics",ZHU Danxi put forward some important medical theories such as"the theory of excess of Yang and deficiency of Yin"and"the theory of fire".Based on the concept of"movement was the heart of heaven and earth",the important significance of Qi movement and constant movement of"Xiang fire"to human life was realized.Based on the sports concept of"extreme things must be reversed"and"the gentleman should be careful to move",the author realized the great harm to the human body caused by the rash movement of"fire"and advocated the idea of"careful movement"for health preservation.Based on the cultivation view of"heart regulating temperament",the author put forward"king fire mastering prime minister fire",emphasized the active role of"heart"of"king fire",cultivated the"nature"of morality,controlled the"emotion"of desire,and maintained the constant movement of"corresponding fire"and supplemented life.Applying the cultivation view of"mastering static without desire"to health but disease required that through tempering appetite and lust,people's natural desires conformed to the Confucian"reason",in order to be no severely ill and spend the whole life.[Conclusion]ZHU Danxi's medical science is rich in connotation,which is a powerful witness of the influence of the reform of Confucianism on medical innovation in Song and Yuan Dynasties.On the one hand,Danxi's"aid theory into medicine"built a strong support for medical innovation,and made his medical theory rise to the height of"heaven theory",so that he was convinced in the Jinyuan period of medical contention;On the other hand,it also demonstrated the all-encompassing universality and supreme authority of"heavenly principles"as cosmic laws.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To explore the effects of mechanical factors on the morphology of the growth plate and proximal femur development, in order to provide a mechanical basis for the mechanism of Cam lesions in femoral acetabular impingement (FAI).Methods:Using CT scan data of hip joint from adolescents, we constructed three-dimensional finite element models of normal and extended proximal femoral epiphyseal growth plates. Dynamic mechanics and position data from daily activities (walk, stand on one and two feet, go upstairs and downstairs, sit and stand up, squat and stand up) and basketball layup drills were collected from five healthy volunteers using the Vicon system. The mean values of femoral head mechanical loads and positions at peak values, movement onset, and termination were selected for finite element analysis to observe the distribution of equivalent stress, normal stress, and shear stress on the two growth plate models under different activity modes.Results:Successful construction of three-dimensional finite element models for normal and extended proximal femoral epiphyseal growth plates was achieved. Mechanical load values and spatial positions of the femoral head during daily activities and layup movements were obtained. In daily activities, peak equivalent stress values for normal and extended growth plates ranged from 1.6 to 11.0 MPa; compressive stress ranged from 1.7 to 12.0 MPa; tensile stress ranged from 0.5 to 10.0 MPa; and shear force ranged from 0.4 to 7.1 MPa. The compressive stress during walking, standing on one or both feet, going up and down stairs, sitting and standing, and squatting was concentrated in the central and lateral areas; tensile stress was concentrated in the central and medial areas; shear force was concentrated in the medial area and the anterior and posterior edges of the growth plate. During a layup, the compressive stress in the center, outer upper side, and medial edge of the growth plate of the normal model was notably concentrated, with peaks fluctuating between 5.5-19.0 MPa, 5.7-11.0 MPa, and 5.4-7.3 MPa respectively; tensile stress and shear force were concentrated at the inner and outer edges as well as in the central area, with peaks fluctuating between 3.0-24.0 MPa and 3.0-26.0 MPa respectively, these values were significantly different from those observed during daily activities. For the elongated growth plate, compressive stress was concentrated at the central and lateral edges with peaks fluctuating between 17.0-41.0 MPa and 17.0-38.0 MPa respectively; simulated shear stress and tensile stress showed significant concentration at peaks fluctuating between 4.9-34.0 MPa, also significantly different from those observed during daily activities.Conclusion:The difference in mechanical distribution between daily activities, basketball layup training, as well as between normal and extended growth plates may be the mechanical initiating factor in the development of extended growth plates and the formation of Cam lesions, it may be the mechanical initiating factor for the development of extended growth plates and the collision of Cam lesions in FAI.

In the past, hernia and abdominal wall surgery has been ignored, which may endanger the life of patients due to untimely treatment. In 1997, the concept of tension-free hernia repair was introduced to China. Chinese hernia and abdominal wall surgery entered a new era and developed rapidly. In 2015, scholars in China decided to create our own Hernia Registry. In 2017, Hernia Registry was officially released, and the Chinese Hernia Surgery Alliance was established in the same period. The Chinese Hernia Registry has became the second largest Hernia clinical registry database in the world. Although the follow-up rate needs to be improved, it is possible to have a preliminary understanding and analysis of the incidence of hernia disease in China. There are many difficulties in its application, and it requires the multi-level coordination and long-term commitment. The authors hope that through this work, the diagnosis and treatment of hernia and abdominal wall can be improved, and the ability of communication and cooperation at home and abroad will be enhanced, benefiting the general population of hernia patients.

Objective To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.Methods Between December 2012 and April 2015,a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town,Banzhuang Town and Tashan Town,Ganyu District,and 9 urban communities in Xinpu District and Haizhou District,Lianyungang City using epidemiological survey method of cluster sampling.Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack,6 592 people at high risk of stroke were finally screened out.Ultrasound was used to detect carotid plaques.The subjects were divided into plaque-free group and plaque group.The latter was further divided into stable plaque group and unstable plaque group.Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability.The odds ratio (OR) and 95％ confidence interval (CI) were calculated.Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.Results Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques,while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques.Using the lowest quintile (Q1) of LHR as a reference,carotid plaque risk increased significantly with the increasing LHR (Q2:OR 1.448,95％ CI 1.082-1.937,P =0.013;Q3:OR 2.414,95％ CI 1.754-3.322,P＜0.001;Q4:OR 2.939,95％ CI 1.945-4.441,P＜0.001;Q5:OR 4.884,95％ CI 3.143-7.115,P＜0.001).ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95％ CI 0.792-0.807;P＜ 0.001),and the optimal cut-off value was 3.00 (sensitivity 68.37％,specificity 75.65％).LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915,95％ CI 2.104-4.040;P＜0.001).The AUC of the LHR predicting unstable carotid plaques was 0.658 (95％ CI 0.633-0.684;P＜0.001).Conclusions LHR was an independent predictor of carotid plaques in high-risk stroke patients.It had higher predictive value for carotid plaques,and its conversion threshold for promoting plaque formation was 3.00.When LHR was ≥3.92,there was a significant increase in the risk of unstable carotid plaques.

OBJECTIVETo verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization.

METHODSA total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group.

RESULTSVAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all<0.05). After treatment, VAS score, UCLA score and ROM in the combined therapy group were remarkably improved as compared with those in the EA group and the rehabilitation group (all<0.05). Regarding the improvements of VAS and UCLA scores, the results in the EA group were better than those in the rehabilitation group (both<0.05). Regarding ROM improvement, the results in the rehabilitation group were superior to those in the EA group (all<0.05). There was no adverse reaction in the two groups.

CONCLUSIONThe combined therapy of EA and Mulligan's mobilization relieves shoulder joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.

OBJECTIVE:To discuss the effect and mechanism of supplementing qi and nourishing yin(SQNY) decoction on intestinal microbiome of mice with Lewis lung carcinoma after treated with cisplatin. METHODS: The model of C57BL/6 mice with lung carcinoma xenograft was established by subcutaneous seeding of Lewis cells and randomly divided into 4 groups (n=16), including saline group (NC group), cisplatin group (DDP group), CAP group (CAP group) and SQNY decoction combined with cisplatin group (DDP+SQNY group). The tumor sizes, weights and intestinal microbiota were detected. The serum levels of IL-6, IL-10, and TNF-α were detected by ELISA. The dendritic cell (DC) and macrophage subtype in spleen of mice models were detected by flow cytometry. RESULTS: ①The mean tumor sizes of mice in DDP group, CAP group, DDP+SQNY groups were all smaller than NC group (P<0.05). And the mean tumor size and weight in DDP+SQNY group were less than the other three groups (P<0.05). The mean animal weights in NC or DDP+SQNY group were higher than those in DDP group and CAP group (P<0.05). ②The mean levels of serum IL-6, IL-10 and TNF-α in DDP+SQNY group were less than those in the other three groups (P<0.05). ③The mean microbiota richness in DDP+SQNY group were less than those in the other three groups (P<0.05). The proportion of fecal microbiota was significantly changed in DDP+SQNY group, including upregulation of Firmicutes phylum and Bifidobacterium Genus, and downregulation of Bacteroidetes phylum(P<0.05). The amount of DC and M1/M2 macrophage subtype in spleen of DDP+SQNY group mice models were more than those in the other three groups (P<0.05). CONCLUSION: It′s suggested that SQNY decoction effectively enhances the anticancer effect of cisplatin by increasing the immune function and changing the intestinal microbiota.

OBJECTIVETo evaluate the effect and safety of Kuanxiong Aerosol (, KA) on patients with angina pectoris.

METHODSBlock randomization was performed to randomly allocate 750 patients into KA (376 cases) and control groups (374 cases). During an angina attack, the KA group received 3 consecutive sublingual sprays of KA (0.6 mL per spray). The control group received 1 sublingual nitroglycerin tablet (NT, 0.5 mg/tablet). Log-rank tests and Kaplan-Meier estimations were used to estimate the angina remission rates at 6 time-points after treatment (1, 2, 3, 4, 5, and >5 min). Logistic regression analysis was performed to observe the factors inflfluencing the rate of effective angina remission, and the remission rates and incidences of adverse reactions were compared for different Canadian Cardiovascular Society (CCS) classes of angina.

RESULTSThe 5-min remission rates in the KA and control groups were not signifificantly different (94.41% vs. 90.64%, P>0.05). The angina CCS class signifificantly inflfluenced the rate of remission (95% confidence interval = 0.483-0.740, P<0.01). In the CCS subgroup analysis, the 3-and 5-min remission rates for KA and NT were similar in the CCSII and III subgroups (P>0.05), while they were signifificantly better for KA in the CCSI and II subgroups (P<0.05 or P<0.01). Furthermore, the incidence of adverse reactions was signifificantly lower in the KA group than in the control group for the CCSII and III subgroups (9.29% vs. 26.22%, 10.13% vs. 20.88%, P<0.05 or P<0.01).

CONCLUSIONSKA is not inferior to NT in the remission of angina. Furthermore, in CCSII and III patients, KA is superior to NT, with a lower incidence of adverse reactions. (Registration No. ChiCTRIPR-15007204).

Aerosols ; adverse effects ; therapeutic use ; Angina Pectoris ; drug therapy ; Case-Control Studies ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Remission Induction ; Treatment Outcome

Objective The purpose of this study is to investigate extracorporeal shock waves therapy on Achilles tendopathy and evaluate its short‐term effectiveness .Methods The subjects were out‐patients with Achilles tendopathy who came to center for Joint Surgery ,Southwest Hospital ,from Dec .1st 2012 to Dec .1st 2013 .The main symptom of these patients showed pain at the hock site ,while the pain could be released with rest .Before the treatment ,routine checkups were performed including X‐ray of ankle joint with normal side and MRI ,which brought out a definite diagnosis and evacuated other reasons resulting pain .The treatment of blast was 2 000 pulse per time ,once a week and four times in total .During the treatment period ,patients were suggested to prevent from strenuous exercise and had the anodyne on the evening of the first day when they underwent the shock waves .VAS and AO‐FAS was used to evaluate the effectiveness with the records ,before the treatment ,after four‐time treatment ,after three‐month treatment .Patients′complications and follow‐ups were recorded and VAS results were assessed with statistical analysis .Results 32 patients had full follow‐ups .22 of them had insertion tendopathy .10 patients had non‐insertion tendopathy .8 patients had bilat‐eral lesion and 24 patients had unilateral lesion .Part of erythema appeared in five patients and could be relieved after rest .One pa‐tient achieved pain release after four‐time treatment ,but fell down going downstairs and resulted rupture of tendon .All patients had VAS assessment for three times ,with the score 8 .2 ± 1 .5 before the treatment(P<0 .01) ,2 .1 ± 0 .8 after four‐time treatment(P<0 .01) and 1 .3 ± 0 .6 after 3‐month treatment(P>0 .05) .The score of AOFAS were 72 .2 ± 5 .1 ,86 .3 ± 5 .2 and 91 .3 ± 3 .5(P<0 .01) .Conclusion When treating on Achilles tendopathy ,extracorporeal shock wave can improve the local symptoms .With minor trauma and reliable outcome ,it brings patients benefits that treat tendon disease without surgery or postponing the surgery .