Objective:To compare the efficacies of 3D printed guide plate assisted positioning and C-arm X-ray machine fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation.Methods:A retrospective cohort study was performed on the clinical data of 60 patients with recurrent patellar dislocation admitted to the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2022. The patients included 29 males and 31 females, with age range of 14-40 years [(28.6±7.6)years]. The 3D printed guide plate was used to locate the femoral tunnel in 30 patients for medial patellofemoral ligament reconstruction (3D guide group), and C-arm X-ray machine was used for another 30 patients (conventional group). (1) CT data of the knee joint were collected before surgery and at 7 days after surgery. Mimics 19.0 software was introduced to measure the distance between the center of femoral tunnel and Sch?ttle point after surgery. (2) Knee Lysholm score and Kujala score were used to evaluate the knee function before and at 3, 6, 9 and 12 months after surgery. (3) At the same time points, Opti-Knee TM 3D knee kinematics analysis system was used to collect the forward and backward displacement, up and down displacement, internal and external displacement, internal and external flipping angle, internal and external rotation angle, and flexion and extension angle of the affected knee joint. The range of each freedom degree was calculated and 6 freedom degree items of 30 healthy people were subjected to knee kinematics analysis. Results:All patients were followed up for 12-15 months [(12.3±0.7)months]. (1) The distance between the center of femoral tunnel and Sch?ttle point in the 3D guide group was (5.5±2.3)mm, smaller than that in the conventional group [(7.6±2.5)mm] ( P<0.01). (2) The Lysholm score and Kujala score of the 3D guide group and conventional gruop gradually increased after surgery (all P<0.01). There were no significant differences in the Lysholm score or Kujala score between the 3D guide group and conventional gruop before surgery and at 12 months after surgery (all P>0.05). At 3, 6 and 9 months after surgery, the Lysholm score of the 3D guide group [(70.4±4.5)points, (86.4±3.1)points, (91.2±3.2)points] and Kujala score [(74.2±5.3)points, (80.9±3.5)points, (85.2±3.2)points] were higher than those of the conventional group [Lysholm score: (67.3±5.2)points, (81.8±2.5)points, (86.2±1.9)points; Kujala score: (69.8±5.2)points, (77.6±2.1)points, (82.7±2.6)points] ( P<0.05 or 0.01). (3) Before surgery, the forward and backward displacement in the 3D guide group and conventional group [(0.6±0.1)cm, (0.6±0.2)cm], up and down displacement [(0.5±0.1)cm, (0.6±0.0)cm], internal and external displacement [(0.7±0.1)cm, (0.6±0.2)cm], and flexion and extension angle [(50.6±10.3)°, (51.6±8.5)°] were less than those in the healthy controls [(1.6±0.3)cm, (1.7±0.5)cm, (1.0±0.4)cm, (63.2±5.1)°] (all P<0.05), while the internal and external flipping angle [(17.5±4.0)°, (17.1±3.8)°] and internal and external rotation angle [(17.9±1.9)°, (17.5±1.5)°] were greater than those in the healthy controls [(11.8±3.6)°, (15.8±4.9)°] (all P<0.05). At other time points, the results of front and back displacement, up and down displacement, internal and external displacement, internal and external rotation angle in the 3D guide group and conventional group were not significantly different compared with the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop were smaller than those in the healthy controls at 3 months after surgery (all P<0.05). At 6 and 9 months after surgery, the flexion and extension angle in the conventional group [(55.0±3.7)°, (57.7±4.8)°] were smaller than those in the healthy controls [(63.2±5.1)°, (63.2±5.1)°] (all P<0.05), but no significant difference was found between the 3D guide group [(61.0±4.8)°, (61.8±4.9)°] and the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop was similar with that in the healthy controls at 12 months after surgery (all P>0.05). Conclusions:Compared with the C-arm X-ray machine, the 3D printed guide plate assisted positioning of femoral tunnel is more simple and accurate for the medial patellofemoral ligament reconstruction in treating recurrent patellofemoral dislocation, together with better early knee function recovery, better satisfaction of the patients, and better and faster restoration of the flexion and extension angle of knee joint kinematic function.

Objective:To analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid carcinoma (PTC) and related parameters in the diagnosis of cervical lymph node metastasis.Methods:The clinical data of 130 patients who underwent ultrasonography in Ningbo Hospital of Traditional Chinese Medicine from Jan. 2019 to Jan. 2022 were retrospectively analyzed. All patients received contrast-enhanced ultrasonography and postoperative pathological examination. According to the pathological diagnosis of benign and malignant tumors, they were divided into PTC group and benign nodule group. In the PTC group, there were 46 males and 40 females, aging 51.79±5.01 years old, ranging from 32 to 63 years old; In the nodule group, there were 25 males and 19 females, aging 52.05±4.89 years old, ranging from 33 to 64 years old. According to the presence or absence of cervical LNM, they were divided into a metastasis group of 31 cases, 17 males and 14 females; age (51.69±6.14 years), ranging from 36 to 63 years; 55 cases in the non-transfer group, 29 males and 26 females, aging (51.75±6.18) years, ranging from 36 to 62 years. Comparative analysis of different nodule properties, presence or absence of LNM, different lesion diameters in imaging manifestations and time-intensity curve (time-intensity curve, TIC) parameters differences, measurement data between groups were conducted by independent sample t test, count data between groups were compared by χ2. The receiver operating characteristic curve (receiver operating characteristic, ROC) was drawn to evaluate the diagnostic performance of TIC parameters for cervical LNM. Results:The proportion of PTC nodules with low enhancement, irregular enhancement, heterogeneous enhancement, unclear lesion boundary, and perfusion defect (72.09%, 87.21%, 88.64%, 69.77%, 70.93%) was significantly higher than that of benign nodules (38.64%, 11.36%) %, 27.27%, 77.27%, 27.27%) ( χ2=13.67, 70.75, 49.69, 25.92, 18.24, P<0.05) ; PTC nodule peak intensity (peak intensity, PI), TIC area under the curve (area under curve, AUC) was significantly lower than that of benign nodules (14.86±2.11dB vs 23.94±3.51dB, 985.14±105.31dB·s vs 1621.14±182.61dB·s) ; time to peak (TTP) was significantly higher than that of benign nodules ( 44.82±5.01s vs 36.95±4.18s) ( t=18.39, 21.36, 8.94, P<0.05) ; there was no significant difference in mean transit time (MTT) ( P>0.05) ; AUC was significantly higher than that of the non-metastatic group (16.86±2.09) dB vs (13.73±1.42) dB, (1163.54±131.41) dB·s vs (884.59±93.25) dB·s ( t=8.25, 11.46, P<0.05) ; The PI and AUC of PTC patients with lesion diameter ≤1.5 cm were significantly lower than those of patients with lesion diameter > 1.5 cm (11.56±1.94) dB vs (15.93±2.46) dB, (876.97±100.21) dB·s vs (1020.09±125.41) dB·s ( t=8.39, 5.34, P< 0.05), there was no significant difference in terms of TTP or MTT ( P>0.05) ; the AUC of PI in the diagnosis of cervical lymph node metastasis in PTC patients was 0.888 (95% CI: 0.807-0.969), the sensitivity was 90.91%, and the specificity was 77.42%; The AUC for the diagnosis of cervical lymph node metastasis in PTC patients was 0.972 (95% CI: 0.943-1.000), with a sensitivity of 87.10% and a specificity of 96.36%. Conclusion:The CEUS manifestations of PTC nodules are mostly irregular and heterogeneous low-enhancement, and the TIC-related parameters of PTC nodules and benign nodules are significantly different, and TIC-related parameters have good diagnostic efficiency for patients with cervical lymph node metastasis.

Objective To observe the clinical effects of arthroscopic reconstruction for anterior cruciate ligament ( ACL ) tear using tension-relieving technique and enhanced recovery after surgery ( ERAS ) . Methods Between May 2014 and June 2016, 80 patients with ACL tear were randomly di-vided into 2 equal groups. The experimental group was treated with arthroscopic reconstruction using hamstring tendon autograft and tension-relieving technique followed by ERAS; the control group was treated with arthroscopic reconstruction using hamstring tendon autograft only followed by conventional postoperative re-covery. The 2 groups were compared in terms of knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC ( International Knee Documentation Committee ) , HSS ( Hospital for Special Surgery ) , and Lysholm scores at postoperative 3rd, 6th and 12th months. Results The 80 patients obtained an average follow-up of 12. 3 ± 1. 7 months. Arthroscopy one year postoperation revealed fine ACL growth without laxity or other complications in the experimental group. Joint stiffness appeared in one case at 2 months postoperation and ACL laxity was observed in 3 cases by arthroscopy at 12 months postoperation in the control group. The knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months in the experimental group were significantly better than those in the control group ( P <0. 05 ) . In both groups, the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months and the knee flexion angles at postoperative 2nd, 4th and 8th weeks were all significantly im-proved than the preoperative values ( P <0. 05 ) . Conclusion In arthroscopic reconstruction for ACL tear, tension-relieving technique combined with ERAS can promote functional recovery of the knee and reduce postoperative complications, facilitating early recovery of sports function.

Objective: To evaluate the feasibility, efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs) for neoadjuvant therapy. Methods: Eighty-six patients with stage ⅢA EGFR-mutant lung adenocarcinoma were assigned to 2 groups (n=43 in each group) according to the random number table method: neoadjuvant targeted therapy group (single oral dose of erlotinib 150 mg per day, for 9 weeks) and neoadjuvant chemotherapy group (2 cycles of pemetrexed combined with cisplatin chemotherapy followed by 3- week discontinuation). Surgical treatment was underwent after imaging efficacy evaluation. Results: In neoadjuvant targeted therapy group, 4 achieved complete response (CR), 25 achieved partial response (PR), giving an objective response rate (ORR) of 67.4%. In pathological response, 8 patients had grade Ⅰ, 20 patients had grade Ⅱ, giving a pathological response rate of 65.1%. The most frequent adverse events (AEs) were rash and diarrhea. In neoadjuvant chemotherapy group, 2 had CR and 17 had PR, giving an ORR of 44.2%. In pathological response, 3 patients had grade Ⅰ, 15 patients had grade Ⅱ, giving a pathological response rate of 41.9%. The main AEs were hematologic toxic effects. The ORR, histological efficacy and hematologic toxicity showed statistical significance between the two groups (P<0.05). The neoadjuvant targeted therapy group had 90.7% resection rate, (299.8±23.4) ml of hemorrhage volume during operation, (5.2±0.4) days of extubation time and 9.3% postoperative complication rate. Corresponding results were 83.7%, (308.9±22.7) ml, (5.4±0.6) days and 11.6% in neoadjuvant chemotherapy group, which showed no statistical significance (P>0.05). Conclusions Neoadjuvant targeted treatment for stage ⅢA lung adenocarcinoma harboring EGFR mutations. The regimen could be considered as a choice of neoadjuvant treatment for patients with stage ⅢA EGFR-mutant lung adenocarcinoma.

Objective To observe the clinical efficacy of acupuncture in treating severe pneumonia complicated with gastrointestinal dysfunction (GIDF).Method Sixty patients with severe pneumonia complicated with GIDF were randomized into a treatment group and a control group, 30 cases in each group. The two groups were both given conventional Western medications. In addition, the treatment group was intervened by acupuncture, and the control group by oral administration of Mosapride citrate capsules and enteral nutrition via nasogastric tube. After 7-day treatment, the changes of GIDF score, intraabdominal pressure, bowel sound and gastric retention were observed in the two groups, and the clinical efficacies were compared.Result The total effective rate was 93.1% in the treatment group versus 78.6% in the control group, and the between-group difference was statistically significant (P<0.05). The scores of GIDF and the indexes (intraabdominal pressure, bowel sound, and gastric retention) were significantly changed after the treatment in both groups (P<0.05). The scores of GIDF and the indexes in the treatment group were significantly different from those in the control group after the intervention (P<0.05).Conclusion Acupuncture can promote the recovery of gastrointestinal function in severe pneumonia patients, since it can significantly improve the intraabdominal pressure, bowel sound and gastric retention.

Objective To analyze the virulence genes expression and drug resistance situation of type three secretion system (TTSS) of pseudomonas aeruginosa in Zhongshan area to provide a basis for clinical anti-infection treatment .Methods Seventy-six clinically isolated strains of Pseudomonas aeruginosa were collected from the Zhongshan Municipal People′s Hospital from July to September 2016 .Four virulence genes exoU ,exoS ,exoT and exoY were isolated from the strains by PCR .The Vitek2 Compact au-tomatic microbiological identification instrument was used to detect the sensitivity of antibacterial drugs .The enumeration data were processed with chi-square test .Results The detection rates of gene exoS and exoY were highest ,which were 52 .6% (40/76) and 63 .2% (48/76) respectively ;genotype exoU(-)exoS(+ )exoT (-)exoY(+ ) were predominant and accounted for 59 .26% .The positive rates of 4 virulence genes had no statistical difference between the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa .The resistance rates in the TTSS positive group to 13 kinds of drugs were commonly lower than those in the TTSS negative group ,the difference was statistically significant .Conclusion The geographic difference exists in virulence genes carrier of pseudomonas aeruginosa .The virulence genes carrying situation in both the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa is similar .

Objective To investigate the effect of cluster needling at scalp points plus gavage of modified Buyang Huanwu decoction on NSC differentiation in rats with ischemic stroke of qi deficiency and blood stasis type.Methods A model of qi deficiency and blood stasis syndrome was made using healthy rats. Dil dye was given for pre-labelling after the success of model making. The rats were randomized into groups A, B, C, D, E and F. Group F consisted of 4 rats and each of the other groups, of 12 rats. A rat model of ischemic stroke of qi deficiency and blood stasis type was made by MCAO at 48 hrs after pre-labelling. After the success of model making, group A was the model group, group B was treated by cluster needling at scalp points, group C was treated by an oral gavage of Buyang Huanwu decoction, group D was treated by an oral gavage of modified Buyang Huanwu decoction, group E was treated by cluster needling at scalp points plus an oral gavage of modified Buyang Huanwu decoction and group F was the sham operation group. The rats were sacrificed at various time points respectively and the materials were taken. By nerve function assessment, double immunofluorescence staining and laser scanning confocal microscopy, a comparative study was conducted to investigate the effects of different treatments on NSC differentiation.Results There was a statistically significant difference in the nerve function score between group B, C, D, E or F and group A after one week of treatment (P<0.01), between group B or E and group A after two weeks of treatment (P<0.05,P<0.01) and between group E and group C or D after one and two weeks of treatment (P<0.01,P<0.05). After one and two weeks of treatment, there were statistically significant differences in Brdu﹢/NeuN﹢ cell count, Brdu﹢/GFAP﹢ cell count, Dil﹢/Brdu﹢NeuN﹢ cell count and Dil﹢/Brdu﹢/GFAP﹢ cell count between group B, C, D or E and group A (P<0.01), between group D or E and group B or C (P<0.01) and between groups E and D (P<0.01).Conclusions Various treatments have a promoting effect on nerve stem cell differentiation in the rats. Of various treatments, cluster needling at scalp points plus gavage of modified Buyang Huanwu decoction has the best therapeutic effect.

Objective To observe the clinical efficacy of acupuncture-moxibustion in treating chronic non-bacterial prostatitis (CNBP), and its effect on the inflammatory cytokines in prostatic fluid. Methods A hundred CNBP patients were randomized into a treatment group and a control group, 50 in each group. The control group was intervened by oral administration of Tamsulosin Hydrochloride sustained-release capsules, while the treatment group was additionally treated with acupuncture-moxibustion. After 28-day treatment, changes of IL-6, IL-8, IL-10, IFN-γ, COX-2, PGE2, TNF-α, MIP-2, and iNOS contents were observed, and the clinical efficacies were compared. Results The IL-6, IL-8, IL-10, IFN-γ, COX-2, PGE2, TNF-α, MIP-2, and iNOS contents were significantly changed after intervention in both groups (P<0.05). The contents of IL-6, IL-8, IFN-γ, COX-2, PGE2, TNF-α, MIP-2, and iNOS contents in the treatment group were significantly different from those in the control group after intervention (P<0.05). The total effective rate was 89.4% in the treatment group versus 78.3% in the control group, and the difference was statistically significant (P<0.05). Conclusions Acupuncture-moxibustion is an effective method in treating CNBP, and can improve the associated indexes of prostatic fluid.

Objective To investigate the effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen.Methods Fifty-one catechumen were selected.After 1 hour training of basic operation in Uromentor virtual reality simulator, all trainees performed special-purpose exercise ( kidney inspection with flexible ureteroscopy ) for 3 hours. Using right kidney inspection, a preliminary assessment for each trainee was made before the special-purpose exercise and data such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and global rating scale ( GRS ) were recorded.The same assessment was performed once again after the special-purpose exercise ( secondary assessment ) , and data were recorded and compared to the preliminary assessment. Results Each trainee made a significant improvement in flexible ureteroscopic skill after the special-purpose training.The parameters such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and GRS of all trainees in preliminary assessment were 14.63 ±1.01 min, 8.62 ± 2.67, 51.05%±20.79%and 10.31 ±2.53, respectively;while in secondary assessment, parameters were 7.71 ±1.13 min, 1.67 ±1.23, 98.04% ±5.42% and 29.14 ±3.01, respectively.The differences between the preliminary assessment and the secondary assessment of each parameter were significant ( P<0.01).Conclusions The Uromentor virtual reality simulator can improve the trainee′s skills of flexible ureteroscopy.It is a good instrument of the flexible ureteroscopic training for catechumen.

ObjectiveTo investigate the clinical promoting effect of crossing nape electroacupuncture on the recovery of swallowing function and recovery from pulmonary infection in post-cerebral infarction patients with tracheotomy.MethodSixty post-cerebral infarction patients with cough reflex disorder and swallowing dysfunction associated with pulmonary infection receiving tracheotomy and tracheal intubation were subjects. They were allocated, using a random number table, to three groups, 20 cases each. In each group, the patients were enrolled in order of visits. The three groups were given the same basic treatment for fighting inflammation, resolving phlegm and improving blood supply. The crossing nape electroacupuncture group received bilateral points Fengchi (GB20), Yifeng (TE17), Dicang (ST4)-to-Jiache (ST6) and Lianquan (CV23) acupuncture with electrodes connected by left-right crossing. The acupuncture group received bilateral points Fengchi, Yifeng, Dicang-to-Jiache and Lianquan acupuncture without electrodes connected. The control group received basic treatment with Western drugs without acupuncture therapy. Observations were carried out using the Kubota’s water drinking test, the Toshima Ichiro Swallowing Assessment and the Clinical Pulmonary Infection Score. The clinical therapeutic effects were evaluated in the three groups.ResultThe therapeutic effects evaluated using the Kubota’s water drinking test and the Toshima Ichiro Swallowing Assessment were better in the crossing nape electroacupuncture group than in the acupuncture group and better in the acupuncture group than in the control group (P<0.05). The score of the Clinical Pulmonary Infection Score decreased in all the three groups. The promoting effect on recovery from pulmonary infection was marked in the crossing nape electroacupuncture group (P<0.01).ConclusionCrossing nape electroacupuncture has a marked improving effect on dysphagia in post-cerebral infarction patients with tracheotomy and tracheal intubation. It can promote recovery from pulmonary infection in post-cerebral infarction patients with cough reflex disorder receiving tracheotomy and tracheal intubation.