BACKGROUND:Laser therapy is a non-invasive and painless treatment that is considered to be an effective method suitable for the treatment of osteoarthritis due to its simplicity and non-invasive nature.Currently,the mechanism of action of laser therapy is unclear and the results of studies on its clinical application are controversial. OBJECTIVE:To review and summarize the latest research progress of laser therapy on chondrocytes,animal experiments and clinical efficacy,and to explore the possible mechanism of laser-mediated multi-pathway biological effects,so as to provide a theoretical basis for further research on the laser treatment of osteoarthritis of the knee joint. METHODS:A literature search was performed in CNKI,WanFang Data,VIP and PubMed databases for relevant literature published from 2018 to 2023,with"laser therapy,low level laser therapy,high level laser therapy,photobiomodulation,knee osteoarthritis,chondrocytes"as the search terms in Chinese and English,respectively.Together with 14 articles searched manually,70 articles were finally included for review. RESULTS AND CONCLUSION:Laser therapy in the treatment of knee osteoarthritis is mainly categorized into two types:low-level laser therapy and high-level laser therapy.Differences in laser parameters and treatment protocols have a direct impact on laser efficacy.When appropriate parameters are used,low-level lasers show positive effects in cellular experiments,animal models,and clinical efficacy.High-level lasers have been less studied in the treatment of knee osteoarthritis,but some preliminary clinical studies have shown positive results.Cell experiments have shown that low-level laser promotes chondrocyte proliferation and cartilage matrix synthesis,thereby reducing inflammatory response.Animal experiments have shown that low-level laser can reduce the release of pro-inflammatory factors,promote cartilage matrix synthesis,inhibit matrix degradation,and effectively improve the repair process of cartilage tissue.Low-level laser is also able to reduce oxidative stress damage and relieve pain in knee osteoarthritis.In clinical trials,both low-and high-level laser can reduce patients'pain and improve functional activities.The combination of laser therapy and exercise therapy modalities may improve the therapeutic effect.Lasers may affect intracellular signaling and cellular functions through photobiological or thermodynamic effects.This provides direct evidence that laser promotes articular cartilage regeneration.

OBJECTIVE: To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. METHODS: Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. RESULTS: The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). CONCLUSION Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Osteoarthritis, Knee/surgery* ; Blood Loss, Surgical ; Robotics ; Knee Joint/surgery* ; Knee Prosthesis ; Retrospective Studies

Objective:To assess the nutritional status of elderly patients with dementia in a memory clinic and to identify patients with malnutrition and patients at risk for malnutrition.Methods:A total of 510 elderly dementia patients were recruited from a memory clinic of the First Affiliated Hospital of Chongqing Medical University.All subjects were assessed with the mini-nutritional assessment short-form(MNA-SF), mini-mental state examination(MMSE), activities of daily living scale(ADL)and neuropsychiatric inventory(NPI). Logistic regression was used to explore potential risk factors and to establish a prediction model.Results:13.33%(68/510)of participants were classified as being malnourished, 52.94%(270/510)as being at risk for malnutrition and 33.73%(172/510)as well nourished.A Logistic regression model for predicting malnutrition identified dysphagia, irritability, physical self-maintenance scale(PSMS), appetite and eating disorders as important influencing factors( OR=4.334, 1.096, 1.121, 1.213, all P<0.05), and MMSE score, family history of dementia and age were important influencing factors for predicting malnutrition/at risk for malnutrition( OR=0.923, 0.517, 1.045, all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition in elderly patients with dementia in the memory clinic are high, and there are many related influencing factors.Early detection and intervention can delay or avoid malnutrition.

Pre-hospital rescue is key to the emergency medical system. Based on the current pre-hospital emergency standardized system construction in China, the authors explored the standardization of pre-hospital emergency system construction, command dispatch and emergency service quality control standardization, pre-hospital classification standardization, pre-hospital emergency service capacity standardization, pre-hospital emergency and intra-hospital emergency connection standardization, standardized training for pre-hospital emergency doctors and nurses. These efforts aim to achieve such rescue and transfer criteria for patients, as " vicinity, urgency, professional needs, and intension of both patients and their families" . Such criteria if met can further reduce emergency response time and shorten the emergency radius, hence improving emergency medical services.

Objective:To evaluate the application value of conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI) in assessing the left ventricular systolic and diastolic functions in patients with restrictive cardiomyopathy (RCM).Methods:Fifteen patients confirmed as RCM by cardiac magnetic resonance imaging or pathological biopsy in Fuwei Cardiovascular Hospital of Yunnan Province from September 2017 to June 2020 were selected. According to left ventricular ejection fraction(LVEF), they were divided into LVEF retention group(LVEF≥50%, 8 cases) and LVEF reduction group (LVEF<50%, 7 cases). Meanwhile, 20 healthy volunteers were selected as the control group. Conventional echocardiography and 2D-STI were used to evaluate left ventricular systolic and diastolic function, including left ventricular end-diastolic diameter (LVEDd), LVEF, mitral valve blood flow spectrum peak E/peak A, peak E deceleration time (EDT), tissue Doppler mitral valve ring average early diastolic peak velocity (e′), E/e′ ratio, isovolumetric relaxation time (IVRT), left atrial volume index (LAVI) and speed of tricuspid regurgitation (TVR), tricuspid annular plane systolic excursion (TAPSE), left ventricular longitudinal strain (LS) and circumferential strain (CS). Then the differences and similarities between the two RCM groups and the control group were compared.Results:There was no significant difference of LVEF between LVEF retention group and the control group ( P>0.05), and LVEF in LVEF reduction group was significantly lower than that in control group ( P<0.05). LVEDd in LVEF retention group was significantly smaller than that of LVEF reduction group ( P<0.05), but was not statistically different from the control group ( P>0.05). Values of E/A, E/e′, LAVI and TVR in LVEF retention group and LVEF reduction group were significantly greater than the control group (all P<0.05), and there was no statistically significant difference between the two RCM groups ( P<0.05). Values of e′, EDT, IVRT and TAPSE in LVEF retention group and LVEF reduction group were significantly lower than the control group (all P<0.05), and there was no statistically significant difference between the two RCM groups (all P>0.05). The global LS and LS of AP4, AP3, and AP2 showed significantly different among the 3 groups (all P<0.05). The global and basal, middle, apical segmental CS in LVEF retention group were significantly larger than those in LVEF reduction group (all P<0.05), but they were not significantly different from the control group (all P>0.05). Conclusions:All patients with RCM show left ventricular diastolic dysfunction in conventional echocardiography, and show gradually reduced left ventricular systolic function and left ventricular remodeling. RCM patients with normal LVEF demonstrate decreased myocardial systolic function, and left ventricular global LS could be used as a sensitive indicator to predict myocardial systolic function.

Objective: To detect the possible molecular mechanisms of the formation of vessels that encapsulated tumor clusters (VETC) and identify the relationship between vimentin protein expression in endothelial cells and contrast-enhanced ultrasound characters in VETC (+ ) hepatocellular carcinoma (HCC). Methods: A total of 64 paraffin embedded HCC tissue samples were collected, all of which the tumor diameters were between 2 cm and 5 cm measured by the preoperative ultrasound. Immunohistochemistry staining for CD34 was used to detect the formation of VETC and the expressions of angiopoietin-2 (Ang-2) and vimentin were also determined. Human umbilical vein endothelial cells (HUVECs) were treated with 150 ng/ml recombinant human Ang-2 protein (rhAng-2) at various times and the protein expression of vimentin was detected by western blot assay. The contrast-enhanced ultrasound characters were also analyzed in both VETC (+ ) and VETC (-) HCC. Results: Tumor clusters encapsulated by vessels to form cobweb-like networks, which were identified as VETC phenotype, were observed in 27 HCC tissues (42.18%). In VETC (+ ) HCC tissues, Ang-2 was overexpressed in tumor cells and endothelial cells while vimentin was only upregulated in endothelial cells. With the treatment of 150 ng/ml rhAng-2 protein, the expression of vimentin in HUVECs was 0.878±0.102 and 0.918±0.092 at 12 h and 36 h, significantly upregulated when compared to the 0.322±0.061 at 6 h (P<0.01). In contrast-enhanced ultrasound, a crack and tendon-like filling character was observed in VETC (+ ) HCC during the arterial-phase, while the large scale and diffuse-like filling character was observed in VETC (-) HCC. The filling time of unit diameter in VETC (+ ) HCC was (3.95±0.22)s, significantly longer than (2.28±0.27)s of VETC (-) HCC (P<0.01). Conclusions The overexpressions of Ang-2 and vimentin are positively correlated with the formation of VETC and considered as potential therapeutic targets of VETC (+ ) HCC. The crack and tendon-like filling characters in arterial-phase of contrast-enhanced ultrasound indicates the VETC (+ ) HCC.

The occurrence of malignant tunors is increasing annually around the world.In every year,8.2 million patients died of malignant tumors in which about 90％ patients died of malignant tumors associated multiple organs metastases.Inhibiting tumor metastasis is the key event to prolong the survival time of patients.With the further research,tumor-vessel associated extravascular tumor metastasis is playing an increasingly important role in the clinical application.This paper summarizes the new developments of tumor-vessel associated extravascular tumor metastasis to provide possible ideas for the therapy of malignant tumors.

Objective To investigate the diagnostic and prognostic value of serum miR-155 for pancreatic cancer.Methods A total of 110 pancreatic cancer patients,70 chronic pancreatitis and 58 healthy individuals who admitted to the First People's Hospital of Hefei between January 2009 and August 2013 were prospectively enrolled.Their serum miR-155 levels were detected by real-time PCR.The receiver operating characteristic curve was employed to estimate the diagnostic accuracy of miR-155 for pancreatic cancer.Correlations between miR-155,carbohydrate antigen 19-9 (CA 19-9) and TNM stages were analyzed.The Kap1an-Meier approach and the Cox model were used to assess the prognostic value of miR-155 for pancreatic cancer.Results Pancreatic cancer patients had significantly higher serum miR-155 when compared either with chronic pancreatitis patients or healthy individuals (P ＜ 0.05 for both).The areas under the receiver operating characteristic curve were 0.82 (95％ CI:0.75 ～ 0.88) for miR-155,and 0.88 (95％ CI:0.82 ～0.93) for miR-155 combined with CA19-9.MiR-155 increased as the TNM stages advanced,and it was positively correlated with CA 19-9 (R2 =0.22,P ＜ 0.05).MiR-155 ≥ 1.46 △CT was independently associated with pancreatic cancer mortality,with a hazard ration of 2.88 (95％ CI:1.26 ～ 6.58).Conclusion Serum miR-155 is a useful biomarker for diagnosis and prognosis of pancreatic cancer.

Objective To explore the association of methyl-CpG-binding protein2 (MeCP2) polymorphisms with female schizophrenia in Chinese Han population.Methods By using the technology based on microarray Chip,gene polymorphism analysis of 4 locus located in the gene MeCP2 was performed in 126 schizophrenia patients fulfilled with DSM-Ⅳ-TR criteria for schizophrenia and in 144 healthy controls.Chi square test was used to compare the inter-group differences of genotypic and allelic distribution.Haplotype case-control association analysis based on linkage disequilibrium was conducted using SNP stats online software after the data was screened.The significance of results was corrected by permutation test.Results To the point of Locus rs1616369 which located in Gene MeCP2,the distribution of the genotype G/A between two groups(24.8％ vs 34.3％) reached significance (P＜0.05) ; rs3027933,genotype G/C(25.6％ vs 34.8％),P＜0.05 ; rs17435,genotype T/A(25.6％ vs 35.5％),P ＜ 0.05 ; rs2239464,genotype C/A (58.5％ vs 71.8％),P＜ 0.05.The distribution prevalence of Haplotype GCCA was 0.1581 in case group,and 0.2389 in control group,reached significant difference(P＜0.05).Conclusion As to female MeCP2 gene,the genotype on the four locations might associate with the onset of schizophrenia,MeCP2 might be susceptibility gene of female schizophrenia.The Haplotype GCCA maybe the protective factor.

Objective　To analyze the clinical indications,efficacy and safety of Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi based on our experience.Methods　From June 1992 to September 2010,a total of 10,452 patients (6060 males and 4392 females)with a mean age of (47.6 ± 13.7) years (7 months-93 years) received MPCNL in our center.The mean stone burden was (777.4 ± 740.3) mm2 (20 - 4 080 mm2 ).The data of stone burden,operative techniques,operating time,stone-free rate,major complication,hospital stay and stone composition were investigated.　Results　Of the 10 452 cases,11 801 procedures were performed on 10 876 (5493 left and 5383right) renal units,including 10 102 first stage procedures,1604 secondary procedures,86 third procedures and 9 fourth procedures.There were 11 830 tracts established,including 373 (3.15％ ) tracts of 14 F,7867 (66.50％) tracts of 16 F and 3590 (30.35％) tracts of 18 F.There were 1207 (10.20％),9174(77.55％) and 1449 (12.25％) punctures located in upper,middle and lower pole,respectively.956(8.79％) renal units were managed with multiple tracts,which including 2 tracts in 846 (7.78％) units,3tracts in 85 (0.78％) units,4 tracts in 18 (0.17％) units and 5 tracts in 7 (0.06％) units.Pneumatic lithotripsy was used in 8563 (72.56％) procedures,Holmium:YAG laser lithotripsy was used in 2981(25.26％)　procedures and Pneumatic lithotripsy + Holmium: YAG laser lithotripsy was used in 257(2.18％) procedures.762 (7.29％) cases needed ESWL to clean the stone after MPCNL.The average operating time was ( 101.3 ± 44.2) min ( 10 -240 min).The stone-free rate of MPCNL was 89.9％,which increased to 93％ by adjunctive ESWL.And the mean hospital stay was ( 13.2 ± 6.4) days (2 - 72 days).The major complications happened on 321 (3.07％) cases,including 294 (2.81％ ) cases of blood transfusion,12 (0.11％ ) cases of sepsis,2 (0.02％) cases of renal abscess,9 (0.09％) cases of pleura injury,2 (0.02％) cases of colon injury and 2 (0.02％) cases of death.53 (0.51％) cases needed selective renal arterial embolization to achieve hemostasis.The main stone compositions were analyzed in 4345 cases.Calcium oxalate,calcium phosphate,magnesium ammonium phosphate,uric acid,ammonium urate,carbapatite and cystin were 91.74％,90.33％,14.91％,17.77％,4.83％,8.47％ and 0.51％,respectively. Conclusions　MPCNL is an effective and safe treatment option for all kinds of upper urinary calculi in patients at all ages with a high stone free rate and low major complication rate.