BACKGROUND:Developmental dysplasia of the hip often leads to limb deformities in children,and the research related to its diagnosis and treatment has been gradually clarified.Recently,the finite element method has been paid attention to by scholars in the research related to developmental dysplasia of the hip because of its advantages. OBJECTIVE:Through literature search and review of the relevant research progress of finite element method in children's developmental dysplasia of the hip and treatment,analyze and summarize its advantages and disadvantages,and explore the direction of further research in the future. METHODS:PubMed,SCI,CBM,and CNKI were searched for relevant articles published from January 2014 to November 2023 with the key words of"developmental dysplasia(dislocation)of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children"in Chinese and English.A small number of long-term articles were included,and 62 articles were finally included for analysis through screening. RESULTS AND CONCLUSION:(1)The mechanical environment of hip joint in children with developmental dysplasia of the hip was abnormal.The pressure in acetabulum was uneven.The stress increased and concentrated;the joint contact area decreased,and the local stress concentrated in femoral neck.(2)In the Pavlik sling and herringbone fixation,the mechanical environment of the hip was improved;the concentrated high stress area disappeared and the joint contact area increased,but the excessive abduction angle led to the increase of stress in the acetabulum and the lateral femoral head.(3)After pelvic osteotomy,the stress environment of hip joint and sacroiliac joint was improved.There was no single hinge in the three kinds of osteotomy,and the stress load position was different according to the age of the children.(4)After peri-acetabular osteotomy,the joint contact pressure was close to normal,but it was difficult to recover in patients with non-spherical femoral head.(5)The postoperative X-ray film findings could not show that the joint contact mechanics was the best.(6)It is indicated that the information that cannot be measured in the body can be obtained by using the finite element method,which can be operated in a virtual environment without the limitation of time and ethics.It can directly see the stress change area of normal and developmental dysplasia of the hip,explain the effectiveness of treatment from the point of view of mechanics,establish a specific finite element model and tailor-made operation plan for patients who need osteotomy.There is no standard or unified standard for the finite element modeling of developmental dysplasia of the hip and the material characteristic parameters of children's hip joint.Due to the inherent limitations of finite element method,it is impossible to analyze the model that contains bone,cartilage,ligament,muscle and other elements at the same time.The operation of finite element analysis is difficult,although it has advantages,it is not universal,and the current research sample size is small,which needs to be further expanded and verified.

Objective:To investigate therapeutic effect of cisplatin sequential recombinant human vascular endostatin thoracic perfusion in treatment of malignant pleural effusion.Methods:A total of 80 patients with malignant pleural effusion in Maoming People's Hospital from January 2018 to February 2021 were enrolled, and all patients were divided into 2 groups according to the random number table methods, each group with 40 cases. The control group was treated with small-bore catheter minimally invasive drainage combined with cisplatin thoracic perfusion, and the study group was treated with small-bore catheter minimally invasive drainage combined with cisplatin sequential recombinant human vascular endostatin thoracic perfusion. And then the clinical efficacy, expressions of vascular endothelial growth factor (VEGF) expression, pain degree and adverse reactions were compared of both groups.Results:The treatment efficacy rate of the study group was higher than that of the control group [90% (36/40) vs. 75% (30/40)], and the difference was statistically significant ( χ2 = 5.04, P < 0.05). After treatment, the level of VEGF in pleural fluid and serum of the study group was lower than that of the control group [(304±106) pg/ml vs. (598±159) pg/ml,(103±43) pg/ml vs. (189±49) pg/ml], and the difference was statistically significant ( t = 6.62, P < 0.001; t = 6.23, P < 0.001). After treatment, the visual analogue scale (VAS) score of the study group was lower than that of the control group [(3.7±0.3) scores vs. (4.4±0.7) scores], and the difference was statistically significant ( t = 2.10, P < 0.05). The incidence of adverse reactions including stethalgia, fever, nausea and vomiting in both groups had no statistically significant differences (all P > 0.05). Conclusions:Cisplatin sequential recombinant human vascular endostatin thoracic perfusion combined with small-bore catheter minimally invasive drainage can effectively ameliorate clinical symptoms, inhibit the expression of VEGF, and alleviate pain degree with no serious adverse reactions in patients with malignant pleural effusion.

Objective:To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19).Methods:Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV.Results:Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs.Conclusions:The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

Objective To compare the effects of different anesthetics on the recovery of neurologi-cal function after intracranial aneurysm embolization. Methods One hundred patients of both sexes with aneurysmal subarachnoid hemorrhage, aged more than 18 yr, with body mass index of 18. 5-24. 0 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and WFNS grade Ⅰ-Ⅳ, with the thick-ness of subarachnoid hemorrhage more than 4 cm, were divided into 2 groups (n= 50 each) using a random number table: propofol group (group P) and sevoflurane group (group S). After anesthesia induction, group P received intravenous infusion of propofol 100-300 μg·kg-1 ·min-1 , while the end-tidal sevoflu-rane concentration was maintained at 1. 4％-3. 5％ in group S. Immediately before induction (T0 ), imme-diately after the end of induction (T1 ), immediately after successful embolization of aneurysm (T2 ) and at 1, 2, 3 and 5 days after surgery (T3-6 ), central venous blood samples were collected for determination of plasma neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay. The development of postoperative cerebral vasospasm and delayed ischemic neurological deficit was recorded. The patients were followed up, and the Glasgow outcome score and occurrence of newly developed cerebral infarction were recorded within 6 months after surgery. Results There was no significant difference in the concentrations of plasma neuron-specific enolase and S100β protein at each time point, incidence of postop-erative cerebral vasospasm and delayed ischemic neurological deficit, or Glasgow outcome score and inci-dence of newly developed cerebral infarction within 6 months after surgery between two groups (P>0. 05). Conclusion Propofol and sevoflurane exert no effect on the recovery of neurological function after intracra-nial aneurysm embolization.

There have been different views over the resection extent of hilar cholangiocarcinoma worldwide.In this review,we will describe expert-views on the resection extent of hepatic tissue,as well as the hilar vascular resection and reconstruction.We hope this article will be helpful to the optimal operation of hilar cholangiocarcinoma.

Objective To compare the efficacy of laryngeal mask of Supreme and i-gel for the airway management in patients undergoing elective lumbar vertebral surgery in prone position. Methods A total of 264 patients,ASA physical status Ⅰ or Ⅱ,scheduled for elective lumbar verte-bral surgery in prone position under general anesthesia were divided into two groups (n =132)using a random number table:laryngeal mask of Supreme group (group S)and laryngeal mask of i-gel group (group I).The laryngeal mask of Supreme or i-gel were respectively placed in group S and group I im-mediately after anesthesia induction according to manufacturers’specification.Volume-controlled ven-tilation was used to observe the ventilation quality.The number of laryngeal mask insertion,laryngeal mask insertion time and the ventilation quality in supine and prone position were recorded,as well as the airway seal pressure.The position of laryngeal mask was evaluated by fibero ptic examination in both supine and prone positions.The blood on the laryngeal mask was noted.Finally,the occurrence of laryngeal mask related complications was observed.Results One patient in group I was excluded due to the failure of laryngeal mask insertion after three attempts.No significant difference in type of laryngeal mask,insertion time,adjusted cases,peak airway pressure,and fiber optic examination in both supine and prone positions between two groups.Compared with group S,group I required signif-icantly more attempts of insertion (P < 0.01 ).Nevertherless,ventilation quality in prone position was improved and airway seal pressure in supine and prone position increased (P <0.01 or P <0.05) in group I.No significant difference was found in the occurrence of laryngeal mask related complica-tions.Conclusion In the airway management of patient undergoing elective lumbar vertebral surgery in prone position,laryngeal mask of i-gel is more difficult to be inserted but can maintain higher air-way seal pressure compared with laryngeal mask of Supreme.

The three‐dimensional digital substraction angiography (3D‐DSA) significantly elevated detection rate of intracranial small vessel aneurysms in recent years .It has become the novel gold standard diagnosing antracranial small vessel aneurysms .The present article made a review on 3D‐DSA value for diagnosis ,treatment and prognostic assessment of intracranial small vessel aneurysms .

As a new technique ,CT spectral imaging can obtain two images of different energy level at same phase simultaneously ,then immediately rebuild high definition monoenergetic images ranging from 40 kV to 140 kV .It provides reliable data and information for early qualitative and quantitative diagnosis of diseases ,which possess huge potential in clinical and science research ;and more extensive developing space for developing of scientific research and clinical application .

Objective To study curative effect of core decompression and autologous bone marrow stem cell transplantation combined with traditional Chinese medicine in the treatment of early femoral head necrosis (ANFH).Methods 30 patients with femoral head necrosis treated by different methods were divided into 3 groups: core decompression A group) 10 cases(12 hips) ;core decompression pus stem cells transplantation(B group) 10 cases(13 hips) ;core decompression pus stem cells transplantation combined with traditional Chinese medicine(C group) 10 ca-ses( 10 hips) ;The X-ray 、CT MRI、Harris score( HHS) .curative effect were observed.Results The phase of Ⅰ,Ⅱ,Ⅲ,in 3 groups didn't appear deformation and collapse at 3,6,12 months;The score of Harris after 12 months 93 points were higher than that preoperatively 57.5 points(χ 2= 5.81 ,P<0.05) ;The signal ratio of femoral head volume in MRI was 42% before treatment,disappearance of femoral head necrosis after treatment;Total curative effect of B,C group,werehighter than that Agroup(χ2 =3.81,χ2 =3.98,P<0.05).Conclusion The operative treatment of ANFH with core decompression and stem cells transplantation combined with traditional Chinese medicine had the advantage of minimal damage,simplicity,accuracy,and effectiveness.

Objective To study the characteristics and therapeutic effect of femoral neck fractures in young adults by many treatment methods. Methods 32 cases with femoral neck fractures in young adults 21-50 years. Using of tube decompression of the femoral head involvement, fracture of drug injection, intravenous drip and so many ways of delivery, to regular observe their fracture healing and clinical efficacy. Results All 32 cases with femoral neck fracture postoperative follow-up 5-9 months to obtain bone healing;Follow-up to 1 year of hip joint function was basically normal,non-femoral head necrosis. Follow-up to 3 years,32 cases in 26 cases of excellent,good in 5 and poor in example 1. Example 1 due to poor weight -bearing walking premature and older (50 years) appear avascular necrosis of femoral head,the total hip arthroplasty. Conclusion The joint methods have an exact effect in patirnts with femoral neck fracture.The advantages were easy to operate,less trauma and fewer complications,fast recovery ,easy to promote.