The American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the American Society of Regional Anesthesia and Pain Medicine collaborated to develop an evidence-based study about the safe and effective use of Ketamine in total joint arthroplasty(TJA). Based on the systematic review and Meta-analysis of several studies, the following conclusions are drawn: Ketamine can effectively relieve the postoperative pain of patients; Ketamine can effectively reduce the occurrence of postoperative nausea and vomiting; Ketamine can reduce the use of postoperative opioids; intraoperative use of Ketamine does not increase the incidence of postoperative adverse reactions. The above conclusions are graded according to the strength of evidence support. This article interprets the guidelines to provide reference for addressing the effectiveness and safety of Ketamine use in TJA.

With the advent of an aging society, the proportion of acetabular fractures in the elderly is increasing. Acetabular fracture belongs to intra-articular fracture. The treatment principle should be to restore the continuity of articular surface anatomy and the concentric relationship between the acetabular load bearing area and the femoral head as far as possible, rebuild the stability of the hip joint, promote the functional recovery of the hip joint, and help patients to carry out functional exercise at an early stage, so as to obtain a good prognosis. However, the treatment plan of the elderly is different from that of young patients due to problems such as insufficient bone mass, basic diseases and physiological weakness, which is a new challenge for orthopedic doctors. In this paper, the selection of different treatment schemes for elderly acetabular fracture is summarized, in order to provide help for clinicians in the treatment of elderly acetabular fracture.

Objective:To construct "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " based on the Delphi method, and to provide a methodological basis for consensus construction.Methods:After systematic search and evaluation of the literature related to chronic inducible urticaria, the first draft of "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " was written, and a questionnaire was designed for expert consultation. A representative sample of 25 experts was selected to conduct two rounds of correspondence consultation via electronic questionnaire in strict accordance with the Delphi method, and the content of the consensus was revised and improved according to the consultation results.Results:The response rates in the two rounds of questionnaire consultation were both 100%, and the expert authority coefficient was 0.92 ± 0.09. In the first round of consultation, the coefficients of variation (CV values) of 9 items were greater than 20%, and the mean agreement degree of 3 items was less than 7 points; in the second round of consultation, the CV values of all items were less than 15%, the agreement degree of the above 3 items whose mean agreement degree was less than 7 points in the first round of consultation all rose to over 7 points, and the median agreement degree of all items was greater than or equal to 8 points. Reliability analysis of the two rounds of questionnaire results showed that the Cronbach α coefficient and standardized Cronbach α coefficient were both greater than 0.9; the P values in the agreement tests by using Kendall′s coefficient of concordance for the two rounds of questionnaire results were both less than 0.001, and the Kendall′s coefficients of concordance were 0.170 and 0.219 in the first and second rounds of questionnaire consultation, respectively. Conclusion:The Delphi method-based "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " is highly representative, authoritative and reliable; this study also provides a methodological reference for the formulation and research of consensus.

Objective:To explore the immune infiltration cells in rheumatoid arthritis (RA) synovial lesions, and to provide new research directions and therapeutic targets for the pathogenesis and treatment of RA.Methods:The three gene expression data sets GSE77298, GSE55457 and GSE1919 were downloaded from gene expression omnibus (GEO) (http://www.ncbi.nlm.nih.gov/geo), and the data were merged with Perl. The "limma" package was used to adjust batch differences. In R, "CIBERSORT" software was used to obtain the expression matrix of 22 kinds of immune cells corresponding to RA synovial tissue samples and normal synovial tissue samples were analyzed with the three packages of "e1071", "parallel" and "preprocessCore". Perl was used to screen samples with P<0.05 in the immune cell matrix. R's "barplot" function was analyzed by the percentage of 22 immune cells in samples with P<0.05. The "pheatmap" package of R was used to visualize heatmaps, and "corrplot" package was used to draw correlation heatmaps. The "vioplot" package of R was used to draw violin plots of differences via the wilcox test. Results:The results of immune cell infiltration analysis showed that in RA synovial tissue samples and normal synovial tissue samples at P<0.05, B cells naive and natural killer cells resting were under-expressed in RA synovial tissue, and plasma cells, mast cells resting, macrophages M1, B cells memory and T cells regulatory were highly expressed in RA synovial tissue. This study also found that in the same sample, the correlation coefficient between natural killer cells resting and neutrophils ( r=0.91) was the highest, indicating synergistic effect between the two. In the same sample, the correlation coefficient between macrophages M0 and plasma cells ( r=-0.88) was the lowest, indicating antagonistic effect between the two. Conclusion:The immune infiltrating cells in RA synovial lesions discovered in this study provide a certain theoretical basis and research direction for the research on the disease mechanism and treatment of RA.

Objective:To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital, and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods:A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca, including transport constant(K trans), rate constant(K ep), percent volume of the extravascular extracellular space(V e)and fraction of the Intraplasmic contrast volume(V p), were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum, maximum, median, mean, area, 10 thpercentile, 25 thpercentile, 75 thpercentile and 90 thpercentile.The correlations between quantitative parameters and GS, and diagnostic efficiencies were analyzed. Results:102 Pca patients were divided into low-grade prostate cancer group(GS≤3+ 4)(n=44)and high-grade Pca group(GS≥4+ 3)(n=58). There were no statistically significant differences in age and location of lesions between the two groups( P>0.05), but there were statistically significant differences in Gleason score, PSA level and lesion diameter between the two groups( U=0.000, 730.000, 711.000, all P<0.05). The median, mean, 10 thpercentile, 25 thpercentile, 75 thpercentile, 90 thpercentile derived from K trans, and K ep(median, mean, 10%, 25%, 75%, 90%)together with maximum of K transand mean for V e were positively correlated with GS( r=0.405 to 0.583, P<0.05), in which mean of K transhad the highest positive correlation( r=0.583, P=0.000). The histogram parameters derived from V pwere negatively correlated with GS( r=-0.301 to 0.341, P<0.05). The area under ROC of 75th percentile derived from K transwas the highest(0.832). When the cut-off value of 75 thpercentile derived from K transwas ≥0.680/min, its Youden index, sensitivity, and specificity were 0.594, 0.776, 0.818, respectively. Conclusions:The three-dimensional histogram of DCE-MRI quantitative parameters has correlation with GS in Pca patients, can be used to discriminate low-grade from high-grade Pca.

With the common occurrence of knee osteoarthritis, total knee arthroplasty has become an effective method for the treatment of middle and late knee osteoarthritis. Continuous passive movement is an effective auxiliary method for rehabilitation after total knee arthroplasty, but it also has some limitations. This article reviews the research progress of continuous passive movement after total knee arthroplasty.

Bone infection is a serious infectious disease in clinical practice due to its difficult treatment and poor prognosis. Therefore, early accurate diagnosis of bone infection is the key for successful treatment. The traditional detection methods is time consuming with lower positive rate. Therefore, it is urgent to find better detection techniques to identify the pathogenic microorganisms of bone infection. In recent years, metagenomic second-generation sequencing technology has been widely used in the diagnosis of clinical infectious diseases because of its advantages of accurate, rapid, efficient and comprehensive diagnosis of pathogenic microorganisms, and can be used as an effective tool for the diagnosis of bone infections. This paper mainly reviews the advantages, disadvantages and development direction of metagenomics next-generation sequencing technology in the diagnosis of bone infection.

Objective: To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Methods: Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Patients were followed clinically every 3 months within one year after procedure. Immediate electrocardiogram was performed in patients with palpitation or choking sensation in chest. The end point of the study was recurrence of any atrial tachyarrhythmia lasting >30 seconds in device interrogation, 24-hour Holter monitoring or 12-lead electrocardiogram after a single procedure. After the ablation procedure, a blanking period of 3 months was allowed according to the guidelines. Procedure time, radiofrequency time, fluoroscopy time, the detection of paroxysmal supraventricular tachycardia, the success rate and the complications were compared between the two groups. Results: There was no difference in the baseline characteristics between the two groups, such as age, gender, BMI, complications, LVEF, LAD (all P>0.05). The duration of procedure ((117.8±51.7)minutes vs.(115.4±36.9)minutes, P=0.79), duration of fluoroscopy((12.5±11.2)minutes vs. (10.4±10.2)minutes, P=0.35), duration of radiofrequency((40.1±12.9)minutes vs. (48.6±44.3)minutes, P=0.48) were similar between the two groups (P>0.05). Compared with S group, discovery of the frequency of atrioventricular node reentrant tachycardia (AVNRT) was significantly lower in GA group (0 vs. 3.6%(10/278), P<0.01), but the difference disappeared with repeat electrophysiological examination when patients become conscious from GA(3.2%(7/220) vs. 3.6%(10/278), P=0.311). The difference of atrioventricular reentrant tachycardia (AVRT) was similar between the two groups(0.9%(2/220) vs. 0.7%(2/278), P=0.841). Compared with S group, reflection of vagus nerve was less in GA group (1.4%(3/220) vs. 8.6%(24/278), P=0.026). After following up of (356±92) days, freedom from atrial fibrillation/atrial flutter/atrial tachyarrhythmia was similar between the two groups(77.9%(162/208) vs. 79.9%(215/269), P=0.818). Conclusion General anesthesia is a promising method to atrial fibrillation ablation, in view of stable patient status and safety for the procedure. There is no difference in complications, recurrence of arrhythmia between the two groups, but detection rate of AVNRT is lower in GA group.

Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.