OBJECTIVE: To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma. METHODS: A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively. RESULTS: Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05). CONCLUSION Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.
Humans ; Robotics ; Osteoma, Osteoid/surgery* ; Orthopedics ; Blood Loss, Surgical ; Retrospective Studies ; Neoplasm Recurrence, Local ; Minimally Invasive Surgical Procedures ; Bone Neoplasms/surgery* ; Analgesics ; Treatment Outcome

Objective:To examine the treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations.Methods:This is a retrospective case series study. Clinic data from 24 children with tracheal stenosis who underwent surgical treatment in the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to March 2023 were retrospectively collected. There were 16 males and 8 females, aged ( M(IQR)) 6.5 (19.6) months (range: 2.2 to 66.3 months) and weighted 5.95 (4.76) kg (range: 3.2 to 20.0 kg). All patients had obvious respiratory symptoms. Eighteen patients underwent cardiac malformation correction and tracheoplasty at the same time (simultaneous group). Six patients in the staged operation group were treated with cardiac malformation correction in the first stage operation and tracheoplasty in the second stage operation due to missed diagnosis or delayed diagnosis of tracheal stenosis or no condition for tracheoplasty. Slide tracheoplasty was used to correct tracheal stenosis in both groups. The recovery of the children was followed. Wilcoxon sign rank test was used for comparison between the two groups. Results:There was no death during the perioperative period and hospitalization. In the simultaneous group, 1 case with delayed chest closure underwent bedside chest closure after 52 hours, 2 cases were intubated again after operation, and 1 case was implanted with an endotracheal stent. The duration of mechanical ventilation was 40.5 (39.6) hours (range: 19.0 to 438.8 hours). In the staged group, there was 1 case of re-intubation after operation, combined with left vocal cord paralysis and respiratory multidrug-resistant bacterial infection ( Acinetobacter baumanii). One patient underwent 3 times of bronchoscopic balloon dilatation of the right middle bronchus, and heart rate returned to normal range. The duration of mechanical ventilation was 19.0 (21.4) hours (range: 17.1 to 96.7 hours). During follow-up, a patient in the simultaneous group was prone to respiratory infection and had good exercise tolerance, 1 case in the staged group still had sputum stridor in the throat 3 months after the operation, and symptoms improved significantly 6 months after the operation. The other children didn′t have obvious respiratory symptoms. Conclusions:The diagnosis of tracheal stenosis may be delayed or missed when tracheal stenosis is complicated by non-vascular ring cardiac malformations. One-stage correction of tracheal stenosis and cardiac malformation can achieve a good outcome.

Objective:To investigate the effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty (TKA).Methods:A total of 411 patients with end-stage knee osteoarthritis who underwent primary TKA in the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2023 were retrospectively analyzed. There were 89 males and 322 females, aged 68.05±5.91 years (range, 50-82 years). The body mass index was 26.8±3.7 kg/m 2 (range, 17.4-39.8 kg/m 2). The group was divided into a preoperative thrombosis group (47 cases) and a preoperative none-thrombosis group (364 cases) according to whether or not there was a combination of old muscular calf vein thrombosis before TKA. The clinical characteristics (location and size) and lower limb swelling were observed, and the American Knee Society (AKS) score, visual analogue scale (VAS) and Villalta score were recorded to compare the differences between the two groups. Results:All patients successfully completed the operation and were followed up for 7.4±1.1 months (range, 6-9 months). Postoperative deep venous thrombosis (DVT) occurred in 96% (45/47) of the patients in the preoperative thrombus group, which was greater than the 38.5% (140/364) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=55.184, P<0.001). 29% (13/45) of the patients who developed DVT postoperatively in the preoperative thrombus group had DVT located in the main vein, which was greater than the 9% (12/140) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=12.028, P<0.001). 51% (23/45) of patients with DVT after operation had thrombosis ≥6 mm, which was higher than 34% (47/140) of patients in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=4.454, P=0.035). The rate of thigh swelling on postoperative day 3 was 8.42%±3.50% in the group with preoperative thrombus and 7.80%±4.12% in the preoperative none-thrombus group, and the differences were not statistically significant ( t=-0.995, P=0.320). The rate of calf swelling on postoperative day 3 was 8.14%±3.40% in the preoperative thrombus group, which was greater than the 5.51%±3.45% in the preoperative none-thrombus group, and the difference was statistically significant ( t=-4.923, P<0.001). Postoperative AKS scores were elevated in both groups and were greater than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in AKS score between the two groups before operation ( P>0.05), and the AKS scores in the preoperative thrombus group were smaller than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). Postoperative VAS scores were reduced in both groups and were smaller than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in preoperative VAS scores between the two groups ( P<0.05), and the VAS scores in the preoperative thrombus group were greater than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). The Villalta score of patients with DVT after operation in the preoperative thrombus group was 4.47±2.47 at the last follow-up, which was greater than that of the preoperative none-thrombus group, which was 2.90±1.92, and the difference was statistically significant ( t=-4.395, P<0.001). Conclusion:Preoperative combined old muscular calf vein thrombosis increases the incidence of postoperative DVT and the dangerousness of DVT is higher.

Objective:To examine the treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations.Methods:This is a retrospective case series study. Clinic data from 24 children with tracheal stenosis who underwent surgical treatment in the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to March 2023 were retrospectively collected. There were 16 males and 8 females, aged ( M(IQR)) 6.5 (19.6) months (range: 2.2 to 66.3 months) and weighted 5.95 (4.76) kg (range: 3.2 to 20.0 kg). All patients had obvious respiratory symptoms. Eighteen patients underwent cardiac malformation correction and tracheoplasty at the same time (simultaneous group). Six patients in the staged operation group were treated with cardiac malformation correction in the first stage operation and tracheoplasty in the second stage operation due to missed diagnosis or delayed diagnosis of tracheal stenosis or no condition for tracheoplasty. Slide tracheoplasty was used to correct tracheal stenosis in both groups. The recovery of the children was followed. Wilcoxon sign rank test was used for comparison between the two groups. Results:There was no death during the perioperative period and hospitalization. In the simultaneous group, 1 case with delayed chest closure underwent bedside chest closure after 52 hours, 2 cases were intubated again after operation, and 1 case was implanted with an endotracheal stent. The duration of mechanical ventilation was 40.5 (39.6) hours (range: 19.0 to 438.8 hours). In the staged group, there was 1 case of re-intubation after operation, combined with left vocal cord paralysis and respiratory multidrug-resistant bacterial infection ( Acinetobacter baumanii). One patient underwent 3 times of bronchoscopic balloon dilatation of the right middle bronchus, and heart rate returned to normal range. The duration of mechanical ventilation was 19.0 (21.4) hours (range: 17.1 to 96.7 hours). During follow-up, a patient in the simultaneous group was prone to respiratory infection and had good exercise tolerance, 1 case in the staged group still had sputum stridor in the throat 3 months after the operation, and symptoms improved significantly 6 months after the operation. The other children didn′t have obvious respiratory symptoms. Conclusions:The diagnosis of tracheal stenosis may be delayed or missed when tracheal stenosis is complicated by non-vascular ring cardiac malformations. One-stage correction of tracheal stenosis and cardiac malformation can achieve a good outcome.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty (TKA).Methods:A total of 277 patients with knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to September 2022 were retrospectively analyzed. There were 72 males and 205 females, aged 69.16±6.77 years (range, 52-87 years), body mass index 27.01±3.81 kg/m 2 (range 18.14-39.01 kg/m 2). The patients were divided into three groups according to the preoperative tilt angle of the patella: tilt angle<5° for mild tilt group, 5°≤tilt angle<10° for moderate tilt group, and tilt angle≥10° for severe tilt group. There were 103 cases in the mild group, 137 cases in the moderate group, and 37 cases in the severe group. The preoperative and postoperative visual analogue scale (VAS), Hospital for Special Surgery (HSS) score and Feller's score of patella were compared. Results:All patients were followed up for 15.73±3.06 months (range, 12-22 months). The patellar tilt angle was 6.86°±3.55° preoperatively and 3.63°±2.61° postoperatively ( t=19.086, P<0.001). The patellar tilt angle of mild group, moderate group and severe group decreased after operation, and the difference was statistically significant compared with that before operation ( P<0.05). The anterior knee VAS of the three groups decreased after operation, and the differences were statistically significant compared with those before operation. The anterior knee VAS at 3, 6, and 12 months after operation were lower than those before operation. The differences between groups at 6 and 12 months postoperatively were statistically significant ( P<0.05), with anterior knee VAS scores of 2.59±0.55 and 2.03±0.55 in the severe group being greater than those of 2.15±0.38 and 1.57±0.50 in the mild group and 2.19±0.49 and 1.67± 0.61 in the moderate group. The HSS score of the three groups was increased after operation, and the difference was statistically significant compared with that before operation ( P<0.05), and the HSS scores at 3, 6 and 12 months after operation were higher than those before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the HSS scores of the severe group were 86.27±2.04 and 87.73±2.28, which were lower than those of the mild group 89.02±2.33 and 89.83±1.48, and the moderate group 88.77±2.83 and 89.52±1.95. Postoperative patellar Feller score increased in all three groups, and the difference was statistically significant compared with that before operation ( P<0.05), the patellar Feller score at 3, 6 and 12 months after operation was higher than that before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the patellar Feller scores in the severe group were 18.32±1.99 and 20.32±1.60, which were lower than those in the mild group 20.92±1.01 and 23.07±1.39 and the moderate group 20.91±1.95 and 22.69±1.59. Conclusion:In TKA patients without patella replacement, the increase of patellar tilt angle before operation can lead to anterior knee pain and reduced knee function.

Objective:To investigate the mechanism by which baicalein alleviates osteoarthritis by regulating Sirtuin (Sirt) to inhibit the senescence of fibroblast-like synoviocytes (FLS).Methods:FLS were extracted from synovium of non-osteoarthritis patients (3 patients) and osteoarthritis patients (3 patients), and assessed the senescence of FLS in osteoarthritis patients by Western blot, β-galactosidase staining and immunofluorescence, and examined the changing levels of Sirt family proteins and mRNAs in FLS. The relative expression level of Sirt1 in FLS was knocked down by transfection with Sirt1 siRNA, and the antioxidative capacity and senescence degree of FLS were analyzed. Chondrocytes were co-cultured with FLS and functional changes in chondrocytes were detected by Western blot. After inducing FLS senescence with bleomycin (BLM), different concentrations of baicalein were administered to detect the expression levels of Sirt1, p16, and p21 proteins and intracellular reactive oxygen species (ROS). The expression level of Sirt1 in FLS was knocked down, and BLM and baicalein treatments were applied. The relative expression levels of Sirt1 and ROS were detected using Western blot and ROS assays. After BLM-induced FLS senescence, baicalein and Compound C were added. The relative expression levels of phosphorylated AMP-activated protein kinase (pAMPK), nuclear factor erythroid 2-related factor 2 (NRF2), p16, p21, and ROS were detected by Western blot and ROS assays.Results:The relative expression of p16 and p21 in FLS in the osteoarthritic group were 3.66±0.38 and 3.55±0.34, which were higher than those in non-osteoarthritis group 1.00±0.07 and 1.00±0.09 ( t=11.860, P<0.001; t=12.520, P<0.001). The relative expression levels of Sirt1 and Sirt6 in FLS in the osteoarthritis group were 0.30±0.04 and 0.16±0.01, which were smaller than those in the non-osteoarthritis group 1.00 ± 0.03 and 1.00±0.04 ( t=23.840, P<0.001; t=34.130, P<0.001). After baicalein treatment, the relative expression of ROS was 2.58±0.28, 1.65±0.14 and 1.00±0.24 in the BLM, BLM+Bai and control groups, respectively, with statistically significant differences between the groups ( F=35.700, P<0.001), which was greater in the BLM and BLM+Bai than in the control group, and lower in the BLM+Bai than in the BLM group ( P<0.05). The relative expression of pAMPK and NRF2 was 0.28±0.02 and 0.38±0.09 after Compound C+Baicalein treatment, which was lower than that of 0.56±0.07 and 0.60±0.08 in the BLM+Bai group ( P<0.05). The relative expression of ROS increased from 1.75±0.16 to 3.45±0.12 ( P<0.001). The proportion of positivity in the BLM+Bai+Compound C, BLM+Bai and control groups was 47.30%±4.29%, 18.18%±3.89% and 7.70%±3.53% ( F=109.700, P<0.001), respectively, with the BLM+Bai+Compound C group being higher than that in the BLM+Bai group ( P<0.05). Conclusion:The downregulation of Sirt1 expression in patients with osteoarthritis leads to FLS senescence and accelerates the progression of osteoarthritis. Baicalein can inhibit FLS senescence by activating Sirt1/AMPK/NRF2 pathway, which may delay the progression of osteoarthritis and improve the function of chondrocytes.

Objective: : The spontaneous intracerebral hemorrhage (ICH) remains a significant cause of mortality and morbidity throughout the world. The purpose of this retrospective study is to develop multiple models for predicting ICH outcomes using machine learning (ML). Methods: : Between January 2014 and October 2021, we included ICH patients identified by computed tomography or magnetic resonance imaging and treated with surgery. At the 6-month check-up, outcomes were assessed using the modified Rankin Scale. In this study, four ML models, including Support Vector Machine (SVM), Decision Tree C5.0, Artificial Neural Network, Logistic Regression were used to build ICH prediction models. In order to evaluate the reliability and the ML models, we calculated the area under the receiver operating characteristic curve (AUC), specificity, sensitivity, accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR). Results: : We identified 71 patients who had favorable outcomes and 156 who had unfavorable outcomes. The results showed that the SVM model achieved the best comprehensive prediction efficiency. For the SVM model, the AUC, accuracy, specificity, sensitivity, PLR, NLR, and DOR were 0.91, 0.92, 0.92, 0.93, 11.63, 0.076, and 153.03, respectively. For the SVM model, we found the importance value of time to operating room (TOR) was higher significantly than other variables. Conclusion : The analysis of clinical reliability showed that the SVM model achieved the best comprehensive prediction efficiency and the importance value of TOR was higher significantly than other variables.

Four unreported monoterpene indole alkaloids, tabernaecorymines B-E (1-4), together with twenty-one known indole alkaloids (5-25) were obtained from the stem bark of Tabernaemontana corymbosa. Their structures and absolute configurations were elucidated by extensive spectroscopy, quantum chemical calculations, DP4+ probability analyses and Mo₂(OAc)₄-induced electronic circular dichroism experiment. The antibacterial and antifungal activities of these compounds were evaluated and some of them showed significant activity against Staphylococcus aureus,Bacillus subtilis, Streptococcus dysgalactiae and Candida albicans.
Tabernaemontana ; Anti-Infective Agents ; Antifungal Agents ; Anti-Bacterial Agents ; Indole Alkaloids

Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.