BACKGROUND:Pelvic tilt,which is often seen in hip diseases,is also a common functional problem after total hip arthroplasty. OBJECTIVE:To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS:The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis,Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023.The patients were divided into three groups,namely,groups A(<2°,n=48),B(2°-3°,n=34),and C(>3°,n=18),according to the severity of pelvic tilt on postoperative 3 day.Statistical data were collected and compared between the pre-and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt,the length of the gluteus medius muscles of the bilateral sides,the heights of the rotational centers of the femoral heads,the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads,and the ratio of changes in the angle of the pelvic tilt.Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes. RESULTS AND CONCLUSION:(1)Pelvic tilt aggravation occurred in the short term after surgery.(2)The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups,with group C>group B>group A.There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months,with the ratio of change being the smallest in group C.There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months.(3)The difference in bilateral gluteus medius muscles decreased gradually after surgery,and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months.(4)The difference between bilateral centers of rotation increased after surgery,and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery.(5)The pelvic tilt angle at 3 days after surgery,the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated(all P=0.000),and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated(P=0.006)(6)The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty.Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery.Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage.

Objective:To evaluate the value of radiomics based on contrast-enhanced spectral mammography (CESM) of internal and peripheral regions combined with clinical factors in predicting benign and malignant breast lesions of breast imaging reporting and data system category 4 (BI-RADS 4).Methods:A retrospective analysis was performed on the clinical and imaging data of patients with breast lesions who were treated in Yantai Yuhuangding Hospital (Center 1) Affiliated to Qingdao University from July 2017 to July 2020 and in Fudan University Cancer Hospital (Center 2) from June 2019 to July 2020. Center 1 included 835 patients, all female, aged 17-80 (49±12) years, divided into training set (667 cases) and test set (168 cases) according to the "train-test-split" function in Python software at a ratio of 8∶2; and 49 patients were included from Center 2 as external validation set, all female, aged 34-70 (51±8) years. The radiomics features were extracted from the intralesional region (ITR), the perilesional regions of 5, 10 mm (PTR 5 mm, PTR10 mm) and the intra-and perilesional regions of 5, 10 mm (IPTR 5 mm, IPTR 10 mm) and were selected by variance filtering, SelectKBest algorithm, and least absolute shrinkage and selection operator. Then five radiomics signatures were constructed including ITR signature, PTR 5 mm signature, PTR 10 mm signature, IPTR 5 mm signature, IPTR 10 mm signature. In the training set, univariable and multivariable logistic regressions were used to construct nomograms by selecting radiomics signatures and clinical factors with significant difference between benign and malignant BI-RADS type 4 breast lesions. The efficacy of nomogram in predicting benign and malignant BI-RADS 4 breast lesions was evaluated by the receiver operating characteristic curve and area under the curve (AUC). Decision curve and calibration curve were used to evaluate the net benefit and calibration capability of the nomogram.Results:The nomogram included ITR signature, PTR 5 mm signature, PTR 10 mm signature, IPTR 5 mm signature, age, and BI-RADS category 4 subclassification for differentiating malignant and benign BI-RADS category 4 breast lesions and obtained AUCs of 0.94, 0.92, and 0.95 in the training set, test set, and external validation set, respectively. The calibration curve showed good agreement between the predicted probabilities and actual results and the decision curve indicated a good net benefit of the nomogram for predicting malignant BI-RADS 4 lesions in the training set, test set, and external validation set.Conclusion:The nomogram constructed from the radiomics features of the internal and surrounding regions of CESM breast lesions combined with clinical factors is attributed to differentiate benign from malignant BI-RADS category 4 breast lesions.

Objective:To introduce a novel technique note about anterior decompression through transoral axis slide and rotation osteotomy (ASRO) and identify its imaging parameters related to osteotomy, and to explore its clinical application value.Methods:CT data of cervical spine of 90 subjects were collected, including 54 males and 36 females. The age ranged from 26 to 72 years, with an average age of 48.7 years. The Mimics software was used to reconstruct the atlantoaxial three-dimensional model. We plan to perform osteotomy on both sides of the axis of the vertebral body in the anteroposterior direction and the ASRO related anatomical parameters were measured, including the minimum osteotomy angle, the maximum osteotomy angle, the minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, the length of the upper articular surface of the axis side mass, the depth of osteotomy at the highest point and lowest point of the axial osteotomy surface and the minimum osteotomy depth. A 56-year-old female patient was admitted to the hospital due to atlantoaxial dislocation with failure of occipital-cervical fusion, difficulty walking, weakness and hypoaesthesia in four limbs. Imaging revealed that narrow space between the transversal walking wire and upper-posterior of the odontoid process, compressing the spinal cord from the front and the back respectively. The ASRO technique was performed on the patient under neuro-electrophysiological monitoring, and the osteotomy angle, osteotomy depth, narrowest width of the upper cervical spinal canal, the medullary, spinal cord angle were measured and Japanese Orthopaedic Association Scores (JOA) cervical myelopathy evaluation were performed after the operation to evaluate the surgical treatment effect.Results:The minimum osteotomy angle and the maximum osteotomy angle was 14.7°± 4.36° and 33.0°± 8.67°. The minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, and the length of the upper articular surface of the axis side mass was 6.0±1.80 mm, 12.2±3.17 mm, and 17.2±1.90 mm, the ratio of the former two to the latter was 34%±8.7% and 70%± 15.0%. The depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 6.0±1.80 mm, 12.2±3.17 mm and 17.2±1.90 mm. The postoperative imaging of the patient showed that the osteotomy angle was 17.1° on left side and 16.5° on right side, and the depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 17.1 mm, 13.2 mm, and 9.1 mm on left side, and 17.4 mm, 11.8 mm, 8.46 mm on right side. All measured values met the ranges which were shown in the imaging anatomical study. The narrowest width of the upper cervical spinal canal increased from 6.58 mm to 15.28 mm, the medullary spinal cord angle increased from 131.7° to 153.8°postoperatively, and the cervical spine JOA score recovered from 6 points to 14 points, suggesting that the postoperative spinal canal space is obvious increased, the compression on the front of the spinal cord was significantly reduced. The patient's symptoms improved significantly.Conclusion:ASRO technique is a good choice for salvage of failed posterior occipitocervical fusion and some irreducible atlantoaxial dislocation because of the anterior bony fusion. It could direct decompress the spinal cord anteriorly, avoid the odontoid resection, which is a safe and feasible new technique.

Objective To investigate the improvement and effect of the method of islet extraction in mice. Methods According to different islet extraction methods, all mice were randomly divided into the common bile duct puncture group (n=100) and common bile duct puncture combined with in situ pancreatic injection group (combined injection group, n=100). Common bile duct puncture combined with in situ pancreatic injection was utilized as the modified method. The islets were selected and purified under stereomicroscope. The morphology and purification of islets were identified. The islet yield and success rate of islet extraction were statistically compared between two groups. The survival of islets after 1 week culture in vitro was analyzed, and the insulin secretion function of islets after 24 h and 4 d culture in vitro was evaluated. Results Compared with the common bile duct puncture group, the islet yield in the combined injection group was significantly increased (P < 0.001). The success rate of islet extraction in both groups was 83% with no statistical significance (P > 0.05). The islets extracted by common bile duct puncture combined with in situ pancreatic injection had intact morphology, high purity and high activity. The survival rate of newly isolated islets was nearly 100% after 24 h culture in vitro. After 1~5 d culture in vitro, the islet cells survived well. After 6 d culture in vitro, the islets showed central death. After culture in vitro for 24 h and 4 d, the islet function of the mice was normal after high glucose stimulation. Conclusions Common bile duct puncture combined with in situ pancreatic injection can increase the islet yield, and the obtained islet cells have high activity and proper function.

Objective To investigate the role of glargine in glucose metabolism improvement and antiinflammation of skeletal muscle in Caveolin-1 silenced type 2 diabetic mice.Methods Multiple low doses of streptozotocin (STZ) intraperitoneal injection and high-fat high-glucose (HFHG) were used to induce type 2 diabetic mice model.The mice were divided into normal control group (NC group) and type 2 diabetic model group (T group).Then according to virus injection and glargine treatment,T group were further divided into type 2 diabetes group (T2DM group),type 2 diabetes with insulin treatment group (insulin group),Caveolin-1 silenced with insulin treatment group (LV-CAV1 group),and scramble virus with insulin treatment group (LV-GFP group).Glucose metabolism was accessed by the fluctuation of blood glucose.TNF-α protein expression in skeletal muscle was detected by Western blot.Results The glycemic control of LV-CAV1 group needed more dosages of glargine (P ＜ 0.05).The expression of TNFαin skeletal muscle was elevated in LV-CAV 1 group than that in LV-GFP and insulin group (P ＜ 0.05).Conclusion The anti-inflammation function and glycemic metabolism improvement of glargine may be associated with the expression of Caveoin-1 in skeletal muscle.

Objective To observe the functional connectivity (FC) pattern linking the hippocampus with the rest of the brain in ischemic stroke patients with cognitive dysfunction,especially the default mode network (DMN).Methods Resting-state functional connectivity magnetic resonance imaging (fMRI) was performed on 15 ischemic stroke patients with cognitive dysfunction (the patient group) and 10 normal elderly controls.The bilateral hippocampus was the region of interest.Correlation analyses yielded a mapping of cerebral functional connectivity activation for both groups.Results Compared with the healthy controls,the patient group showed weakened functional connectivity between the hippocampus and other regions including the cingulate gyrus,the superior,middle and inferior frontal lobes,the inferior parietal lobule and the superior temporal gyrus.But there was enhanced functional connectivity with the cerebellar posterior lobe,the occipital lobe,the medial temporal lobe,the precuneus and the calcarine.The results were significantly different between the two groups.Conclusion The functional connectivity pattern of the hippocampus is impaired in stroke patients with cognitive dysfunction.Reduced functional connectivity between brain regions may be one cause of cognitive dysfunction after stroke,and enhanced functional connectivity may be an appropriate compensatory mechanism.

Objective To investigate the requirement and the attitude of the mental health knowledge and some psychological factors indifferent developed regions. Methods The mental patients, their caregivers and normal people in total of 534 were surveyed with the Zung'sSelf-rating Depression Scale, the Questionnaire of Experience and Attitude of the Psychosis (self-edited), the Questionnaire of Requirementand Attitude on Mental Health Knowledge (self-edited), the Social Support Rating Scale and the Simplified Coping Style Questionnaire. Theresults were compared between the developed and the developing regions. Results Compared with those from developing, the requirementwas more and the attitude was more positive on mental health knowledge in all the people from the developed regions; the patients obtainedand applied more support, and took more positive coping style, less depressive emotion; the caregivers took more positive and negative copingstyles, and more depressive emotion; the healthy people applied more support, and took more positive coping style; the caregivers feltmore un-safety and wished the patients stay in hospital longer. Conclusion Development of the region plays a role in the mental health. Thecaregivers need more support and care.

Objective To analyze the family burden of the caregivers of the psychosis patients in community, and the psychosocial factors which influence the family burden.Methods Conducted some questionnaires to survey the requirement and attitude on mental health knowledge,social support,family burden and coping style of the caregivers of the psychosis patients from the twelve communities which served as the stations for the psychosis of the twelve prefectures organized uniformly by Guangdong provincial disabled federation.Results 360 questionnaire was provided,and 308 replied to our questionnaire effectively.The mean score of each single item of the family burden questionnaire was beyond the moderate.The factor score of the economy burden was the highest among the factots of the economy burden(2.33±0.52),the daily activity of the family(2.17±0.53),the recreation activity of the family(2.00±0.58),the family relationship(2.10±0.54),the body health of the family members (2.03±0.65),and the mental health of the family members(2.09±0.68).The bad emotion and experience with the patients aggravated some factors of the family burden(P<0.05～0.01).According to correlation analysis and regression analysis,there were significant relation and impact between family burden with the requirement and attitude on mental health knowledge,subject support,coping style,age,economy,culture and so on(P<0.05～0.01). Conclusion Negative assumption to mental health will aggravate the family burden,transfering the positive message and changing passive coping style will help to reduce the family burden.

ObjectiveTo investigate the negative emoion and the relative factors in the caregivers of the schizophrenia patients in community. Methods212 caregivers from 12 communities psychotic service stations in 12 prefectures in Guangdong were investigated with the Zung Self-rate of Depression, the experience and attitude of the psychosis, the requirement and attitude on mental health knowledge, the social support scale, the family burden scale and the simply coping style questionaire. ResultsThere were 112 caregivers with no depression (52.8%), 57 with mild depression (26.9%), 30 with middle depression (14.2%), 13 with severe depression (6.1%). More than 50% caregivers worry about unsafty, getting into trouble, worse reputation, genetics, felt scare, strained relationship with the patients. There were significant differences in the hopelessness, the strained relaionship, treatment in other cities, superstition, hospitalization longer between the depression and no depression group, as well as in the economy burden, the interference in the family living, the amusement of family, the family relaionship, the body health and the mental health of the other family members, but no significant in the factors of the requirement and attitude on mental healh knowledge. The caregivers with depression reported less social support than the caregivers with no depression, but there was no difference between these groups in utilization of support. ConclusionThe caregivers of the schizophrenia patients experience negative emotion in community, who need mental and material assistance and the education of the knowledge about diseases.

ObjectiveTo analyse the requirement and attitude to mental health knowledge and the influence factors among the psychosis patients, the caregivers and the healthy pepople.MethodsThe questionnaire survey conducted among the psychosis patients, the caregivers and the healthy pepople from 12 communities which served as the stations for the psychosis where 12 prefectures were organized uniformly by Guangdong Provincial Federation of Disabled Persons.Results1080 sheets of questionnaire were provided, and 986 replied to meet the requirements. The caregivers showed significant difference in requirment and attitude to mental health knowledge compared to the psychosis patients and the healthy pepople(P＜0.05-0.001). The main influence factors were cultural education, regional economic, the frequency of inpatient, the anxiety emotion of the caregivers, which were statistical significance(P＜0.05-0.001).ConclusionIt is lack in the requirement and cognition to mental health knowledge among the psychosis patients, the caregivers and the healthy pepople. Cultural education and economic development are the effective measures to improve the level of the mental health knowledge.