Objective:To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint (CMCJ) Eaton stage II/III arthrosis.Methods:A retrospective study was conducted on a total of 15 cases (16 hands) of patients including 5 males (1 bilateral) and 10 females with CMCJ stage II/III arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022, with mean age of 56.7±6.4 years (range, 46-75 years). The duration from pain to treatment was 7.8±3.2 months (range, 4-14 months). X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation. All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty. The preoperative and last postoperative follow-up radiographs, visual analogue scale (VAS), thumb's Kapandji scores, disabilies of the arm, shoulder, and hand (DASH) scores, grip and pinch strength and time to return to work were compared.Results:All cases were followed up for 19.6±6.3 months (range, 11-36 months). The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal. The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d. The average VAS score decreased from 6.56±1.15 preoperatively to 1.00 (0.75, 1.25). The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00 (7.25, 9.00). The average DASH values improved from 24.06±3.19 to 4.00 (3.00, 5.00). The were significant differences except for Kapandji score ( Z=-4.905, P<0.001; Z=-0.121, P=0.905; Z=-4.846, P<0.001). The mean grip and pinch strength showed improvement from an average of 16.4 (14.13, 18.68) kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference ( Z=-4.617, P<0.001; t=-7.669, P<0.001). Conclusion:Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage II/III arthrosis. By this technique, the patients' existing instability and pain problems can be solved.

Objective To comprehensively analyze the effectiveness of exercise training-based respiratory rehabilitation therapy on patients with occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis"). MethodsLiterature on randomized controlled trials of exercise training-based respiratory rehabilitation therapy for pneumoconiosis patients published from the establishment of the database to July 2023 was retrieved from academic systems such as the China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Database, and China Biology Medicine using bibliometrics method. The RevMan 5.4 software was used for meta-analysis of the selected literatures. Subgroup analysis was conducted to explore the source of study heterogeneity. The funnel plot method was used to test publication bias. Results A total of 55 articles were included, involving 2 436 pneumoconiosis patients in the experimental group and 2 405 pneumoconiosis patients in the control group. The result of random or fixed effect model showed that the six minutes walking distance, the total score of Short from Health Survey-36, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC, arterial partial pressure of oxygen of pneumoconiosis patients increased after respiratory rehabilitation therapy (all P<0.05), while the total score of the St. George's Respiratory Questionnaire and arterial partial pressure of carbon dioxide decreased compared with the conventional treatment (all P<0.05). The result of subgroup analysis showed that the total score of the St. George's Respiratory Questionnaire, FEV₁, and the index of arterial partial pressure of oxygen of pneumoconiosis patients was better in the rehabilitation treatment for ≥six months compared with those

Objectives:To compare the clinical efficacy and safety of uni-portal endoscopic lumbar interbody fusion by using larger-diameter endoscope for single-level lumbar disease via transforaminal approach versus transfacet approach.Methods:46 patients underwent single-level uni-portal endoscopic lumbar interbody fu-sion from June 2018 to February 2022 were enrolled.18 of the patients were male and 28 were female.The mean age was 60.9±10.5 years old(40-80 years).The follow-up time was 3-47 months.Patients were divided into two groups according to the surgical approach,18 of which were included in the transforaminal group,and the remaining 28 were included in the transfacet group,and a full spinal endoscope of 7.1mm inner-di-ameter working-channel was applied to all the patients.The clinical result was evaluated before surgery,at 3d after surgery and the final follow-up,by Oswestry disability index(ODI),visual analogue scale(VAS)for back pain and leg pain,and Japanese Orthopaedic Association(JO A)score.The decompression and implant were evaluated by anteroposterior and lateral X-ray plain film and lumbar CT at 3d after operation.Bridwell criteria were used to evaluate the fusion rate based on CT images for patients followed up for more than 6 months after surgery.Results:No significant differences were found in age,gender,diagnosis,preoperative in-tervertebral height,surgical segment,preoperative ODI,VAS and JOA score between the two groups(P＞0.05).72.2％of the patients in transforaminal group complained unilateral radicular symptom,while 64.3％of the patients in transfacet group suffered from bilateral radicular symptoms(P=0.020).The average operation time was 327.7±89.9min in the transforaminal group,significantly longer than the 385.9±96.7min in the transfacet group(P=0.047),and the mean length of hospital stay in the transforaminal group was 14.8±6.0d,shorter than that of 19.5±7.8d in the transfacet group(P=0.038).75％of the patients in transfacet group underwent unilater-al laminotomy with bilateral spinal canal decompression(ULBD).The ODI scores,back and leg pain VAS scores and JOA score were significantly improved postoperatively and at the final follow-up in both groups(P＜0.05),while no statistical differences between groups(P＞0.05).Postoperative intervertebral height significantly increased in both group(P＜0.001),but no statistical difference was found between groups(P＞0.05).The compli-cation rate was comparable between two groups,without severe intraoperative or postoperative complication.A-mong the 21 patients who were followed up for more than 6 months and received CT examinations,20(95.2％)presented bony fusion at surgical segment,and there was no statistical difference between the two groups in fusion rate.Conclusions:Both the transforaminal approach and the transarticular protrusion ap-proach are safe and effective for the single-level lumbar interbody fusion under single-hole coaxial large channel endoscopy,and the transforaminal approach results in shorter operation time and shorter hospital stay.

Objectives:To explore the clinical outcomes of single-level full-endoscopic lumbar interbody fu-sion for degenerative lumbar spine disorders combined with osteoporosis.Methods:24 consecutive patients with degenerative lumbar spine disorders who underwent single-level full-endoscopic lumbar interbody fusion and were detected by dual-energy X-ray absorptiometry(DXA)during hospitalization for bone mineral density(BMD)from June 2018 to February 2022 were enrolled,including 7 males and 17 females with an average age of 66.0±9.9 years old(range 44-80 years).The follow-up period was 21.6±12.6(3-47)months after oper-ation.And the patients were divided into two groups of osteoporosis group(containing 8 osteoporotic cases)and control group(containing 16 non-osteoporotic cases).Anti-osteoporosis therapy was initiated on the diagnosis of osteoporosis.The surgery was performed using a 7.1mm inner-diameter full-endoscope.The general data and perioperative parameters were compared between the two groups.Before operation,on 3d after operation and at final follow-up,visual analogue scale(VAS)score for back and leg pain,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were used for evaluating clinical outcomes.Digital radiography(DR)and computed tomography(CT)were performed on postoperative 3d for neural decompression and implant position assessment.For patients who received DR examination,cage subsidence and screw loosening were recorded at the final follow-up;For patients who were followed-up for 6 months and more and examined with CT,fusion rate was evaluated.The complications were recorded and compared between the two groups.Re-sults:No significant differences were found in age,gender,diagnosis,preoperative intervertebral height,surgi-cal segment,preoperative VAS scores,JOA scores and ODI between the two groups.The average of the low-est T value was-3.2±0.6 for osteoporosis group,lower than the-1.4±0.8 for control group(P=0.000).The mean operative time was 429.9±135.2min for osteoporosis group,more than the 327.4±68.2min for the controls(P=0.020).There was no significant difference in intraoperative imaging assistance,bleeding,number of cases received unilateral laminotomy for bilateral decompression(ULBD),postoperative intervertebral height and length of hospital stay between groups.The VAS scores for back and leg pain,JOA scores and ODI improved post-operatively and at the final follow-up in both groups comparing with those values before operation(P＜0.05),and there was no significant difference between groups,respectively.The postoperative 3d intervertebral height in both groups increased after surgery(P＜0.01),and none significant difference was found between groups.In the osteoporosis group,asymptomatic cage subsidence happened in 1 case with severe osteoporosis(T=-4.4)due to intraoperative endplate damage during cage implantation,but no symptoms were observed,therefore no spe-cial treatment was given;And dural tear and subsequent incomplete nerve root injury happened to another case in the osetoporosis group,whose symptoms were relieved after symptomatic treatment such as neurotro-phy.18 patients received lumbar DR at final follow-up,and 10 patients received CT evaluation at more than 6 months'follow-up,no significant difference was found in cage subsidence and screw loosening rate and fusion conditions between groups(P=1.000).Conclusions:Single-level full-endoscopic lumbar interbody fusion is safe and effective in the short-term for the treatment of degenerative lumbar spine disorder combined with osteoporosis.

Objective To examine the expression profile of programmed death-ligand 1 (PD-L1) on lung endothelial or epithelial cells,and to determine the specific role of PD-L1 in mouse model of indirect acute lung injury (i-ALI).Methods Eighty male C57BL/6 mice were randomly divided into two parts (both n =40).The effects of different administration routes on the expression of PD-L1 were observed.The mice in each part were randomly divided into sham,i-ALI,i-ALI+small interfering RNA (siRNA) random sequence control,and i-ALI+PD-L1 siRNA which could specifically inhibit PD-L1 expression groups,with l0 mice in each group.i-ALI was reproduced in a mouse model of hemorrhagic shock in combination with a subsequent cecal ligation and puncture (CLP).In sham group,only bilateral femoral arteries were ligated without catheterization or bleeding,and only cecum was separated but perforation was not ligated.Intravenous or intratracheal delivery of PD-L1 siRNA was performed 2 hours following the resuscitation to suppress the expression of PD-L1 on lung endothelial or epithelial cells.The mice in i-ALI+siRNA random sequence control group were given siRNA random sequence without inhibition effect on PD-L1 expression,and those in sham group and i-ALI group were given 100 μL phosphate buffered saline (PBS).The mice were sacrificed at 24 hours after CLP,and samples of blood,lung tissue and bronchoalveolar lavage fluid (BALF) were harvested.Expressions of PD-L1 were determined with flow cytometry.Cytokines and chemokines in plasma,lung tissue and BALF were determined by enzyme linked immunosorbent assay (ELISA).The protein concentration in plasma and BALF and the activity of myeloperoxidase (MPO) in lung tissue were quantitatively measured.The pathological changes in lung tissue were observed under light microscope.Results ① Compared with sham group,PD-L1 expression on lung endothelial or epithelial cells were significantly elevated in i-ALI group [endothelial cells:(27.88 ± 1.53)％ vs.(19.64 ± 1.03)％,epithelial cells:(58.70 ± 8.21)％ vs.(29.23 ± 3.94)％,both P ＜ 0.05].② Mice received intravenous delivery of liposomal-encapsulated siRNA had significantly lower expression of PD-L1 on lung endothelial cells as compared with that of i-ALI group [(21.37 ± 0.76)％ vs.(27.88 ± 1.53)％,P ＜ 0.05].Intratracheal delivery of naked PD-L1 siRNA mainly inhibited the PD-L1 expression on epithelial cell as compared with that of i-ALI group [(31.23±4.71) ％ vs.(58.70±8.21) ％,P ＜ 0.05].The expression of PD-L1 in pulmonary microvascular endothelial cells or pulmonary epithelial cells of i-ALI mice was not affected by siRNA random sequence.③ PD-L1 silencing on pulmonary endothelial cells induced by intravenous delivery of PD-L1 siRNA led to a lower protein ratio of BALF/plasma [(4.48 ± 0.35) × 10-3 vs.(6.11 ± 0.56) × 10-3,P ＜ 0.05] and a decreased MPO activity in lung tissue (U · μg-1 · min-1:2.48 ± 0.47 vs.4.56 ± 0.52,P ＜ 0.05) as compared with that of i-ALI group.Moreover,inflammatory mediator levels such as interleukin-6 (IL-6),monocyte chemoattractant protein-1 (MCP-1),macrophage inflammatory protein-2 (MIP-2) and tumor necrosis factor-α (TNF-α) in lung tissue or plasma were significantly reduced following PD-L1 suppression on endothelial cells as compared with those of i-ALI group [IL-6 (ng/g):177.4±23.2 vs.287.9±57.3,MCP-1 (ng/g):839.6±91.7 vs.1 395.7±211.9,MIP-2 (ng/g):923.7± 107.3 vs.1 700.9±240.2 in lung tissue;IL-6 (ng/L):950.2±192.7 vs.1 828.2±243.6,TNF-α (ng/L):258.7±29.1 vs.443.0 ± 58.1,MCP-1 (ng/L):2 583.8±302.3 vs.4 328.1 ±416.4,MIP-2 (ng/L):1 512.9± 165.6 vs.2 005.9 ± 85.7 in plasma,all P ＜ 0.05],however,there was no significant change in the levels of inflammatory factors in BALF.It was shown in lung tissue histology that PD-L1 silencing on pulmonary endothelial cells induced by intravenous delivery of PD-L1 siRNA led to lessened pulmonary edema and reduced immune cells emigration.Intratracheal delivery of PD-L1 siRNA for PD-L1 suppression on epithelial cells had minimal effects on protein ratio of BALF/plasma,MPO activity,inflammatory mediator expressions in lung tissue,plasma,and BALF as well as lung tissue histology.Conclusion PD-L1 silencing on endothelial cells but not epithelial cells protected mice against hemorrhagic shock-sepsis induced i-ALI.

OBJECTIVE： To prepare Paclitaxel（PTX）nanostructured lipid carriers （NLC） modified by small peptide alanine-glutamic acid-tyrosine-leucine-arginine （AEYLR）， and to evaluate its anti-tumor effect in vitro and in vivo. METHODS： NLC， PTX-NLC （P-NLC） and AEYLR modified P-NLC （A-P-NLC） were prepared by emulsion evaporation-low temperature solidification curing method. Its appearance， particle size， multi-dispersion index（PDI） and Zeta potential were characterized，encapsulation rate，drug loading and in vitro drug release were detected respectively. Using NCI-H1299 and S180 cells as objects， CCK-8 method was adopted to investigate inhibitory effects of free PTX， P-NLC and A-P-NLC （0.44-44.00 μg/mL， by PTX） to those cells. The half inhibition concentration （IC50） was calculated. Using S180 tumor-bearing mice as model animal， anti-tumor effects of free PTX， P-NLC and A-P-NLC （5 mg/kg， by PTX） were evaluated. RESULTS： P-NLC and A-P-NLC were round-like and dispersed evenly. The particle size， PDI and Zeta potential of A-P-NLC were （43.92±0.76） nm， 0.203±0.034 and （－19.77±1.16） mV， which were all increased to certain extent， compared with P-NLC. The encapsulation efficiency and drug loading of A-P-NLC were （95.71±0.68）％ and（1.97±0.25）％， which were both decreased to certain extent， compared with P-NLC. The cumulative release rate of A-P-NLC was（35.17±2.08）％ within 48 h， showing significant sustained-release effect compared with free PTX； the release of A-P-NLC was slower than P-NLC. Compared with free PTX and P-NLC， inhibitory rates of same concentration of A-P-NLC to NCI-H1299 cells and S180 cells were almost increased significantly， while IC50 values were all decreased significantly. There was no death in S180 tumor-bearing mice treated with A-P-NLC and the general condition was good； the volume of tumors was significantly reduced， the mass of tumors was significantly reduced， and the inhibition rate of tumors was significantly increased （P＜0.05 or P＜0.01）. CONCLUSIONS： A-P-NLC has significantly sustained-release effects； its inhibitory rate to NCI-H1299 cells and S180 cells in vitro， and its inhibitory effects on S180 solid tumor in mice are all better than free PTX and P-NLC， while the toxicity is decreased to certain extent.

Objective: To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods: Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results: When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group ( P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group ( P<0.05). There was no significant difference of postoperative in-bed time between the two groups ( t=-0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups ( χ2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference ( χ2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation ( P<0.01), whereas no significant difference between the two groups at either time point was found ( P>0.05). At last follow-up, the results of patients' satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference ( χ2=0.485, P=0.486). Conclusion: The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.

Objective To compare the operative and conservative treatments for senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ using Meta-analysis.Methods A literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,Wanfang Data and CNKI for studies on senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ from the earliest records through June 2016.The relative studies identified were screened by 2 independent authors.The quality of these articles was evaluated using modified Newcastle-Ottawa scale,and the meta-analysis was conducted using Review Manager 5.3.Results A total of 22 articles were brought into this Meta-analysis.The union rate was significantly higher in the operative group than in the conservative group[OR =0.30,95％ CI(0.20,0.44),P ＜ 0.001];the mortality in the operative group was significantly lower than in the conservative group[OR =0.61,95％ CI (0.39,0.96),P=0.03];the complication rate was similar in both groups[OR=1.09,95％ CI(0.76,1.57),P ＜ 0.46].The heterogeneity of all the 3 indexes was low.In the subgroup analysis,the union rate was significantly higher in posterior operations than in anterior operations or conservative treatments (P ＜ 0.05).Conclusion For the elderly patients with dens fracture of type Ⅱ or Ⅲ who can tolerate surgery,operative treatment may be more suitable because it can lead to much better prognosis.

Objective To study the effect of comprehensive Chinese medicine therapy,including Chinese herbal medicine fumigation,massage,and quadriceps exercise,on adipokines of visfatin and chemerin content in joint fluid of patients with knee osteoarthritis (KOA),and to explore its possible therapeutic mechanism for KOA.Methods A total of 60 cases of KOA patients were randomly divided into treatment group and control group,30 cases in each group.The treatment group was treated with comprehensive Chinese medicine therapy,and the control group was treated with Chinese medicine fumigation alone.After treatment for 2 weeks,the clinical efficacy of both groups was evaluated,and the changes in the scores of the Western Ontario and McMaster Universities Arthritis Index (WOMAC)were observed.Moreover,the contents of visfatin and chemerin in jointfluid were examined.Results (1) The total effective rate of the treatment group was 96.7％ and that of the control group was 83.3％,the difference being significant (P ＜ 0.01).(2) After treatment,WOMAC scores of both groups were obviously decreased(P ＜ 0.01 compared with those before treatment),and the decrease in the treatment group was superior to that in the control group (P ＜ 0.01).(3) The contents of visfatin and chemerint in joint synovial fluid of both groups were decreased (P ＜ 0.01 compared with those before treatment),and the decrease in the treatment group was superior to that in the control group(P ＜ 0.05).Conclusion The comprehensive Chinese medicine therapy of Chinese herbal medicine fumigation,massage and quadriceps exercise is effective for the treatment of KOA,and can decrease the contents of visfatin and chemerin in joint fluid of KOA patients,which may be one of its therapeutic mechanisms.

Objective To investigate the clinical value of vacuum pad and body film fixation in radiotherapy for thoracic and abdominal tumors. Methods A total of 240 patients with thoracic and abdominal tumors who were treated with radiotherapy were randomly selected and divided into group A (simple vacuum pad fixation,60 patients),group B(simple body film fixation with unimproved solid plate, 60 patients),and group C(vacuum pad and body film fixation with improved solid plate,120 patients).The difference between groups were analyzed with single variance analysis method. Results The setup error was small in group C and large in groups A and B. There were significant differences in the setup error between the three fixation methods(P=0.000). Conclusions A combination of vacuum pad and body film fixation is better than vacuum pad or body film fixation in radiotherapy for thoracic and abdominal tumors. The combination method has many benefits, including simple and convenient operation, comfortable and repeatable body fixation,reduced artificial errors,and improved positioning precision.