ObjectiveTo explore the central neuroregulation mechanism of heat-sensitive moxibustion for knee osteoarthritis on pain relief. MethodsThirty patients who did not have experience of Deqi （得气） during heat-sensitive moxibustion treatment were assigned to the "non-Deqi group"， while another 30 patients who had experience of Deqi were assigned to the "Deqi group". Both groups received moxibustion at the left Heding （EX-LE2） acupoint. In the Deqi group， after the patients experienced sensation of Deqi at the acupoint， moxibustion was applied at approximately 3 cm from the skin for 10 minutes； in the non-Deqi group， moxibustion was also applied at approximately 3 cm from the skin for 10 minutes. Both groups received treatment once daily for 10 consecutive days. Knee joint pain was assessed before and after treatment using the visual analog scale （VAS）. Resting-state functional magnetic resonance imaging （rs-fMRI） scans were performed on all participants before the first treatment session and after the final session on the 10th day. The fractional amplitude of low-frequency fluctuations （fALFF） maps before and after treatment were processed using the SPM12 module by MATLAB. ResultsAfter treatment， VAS scores in both groups were significantly lower than before treatment （P＜0.05 or P＜0.01）， with the Deqi group showing significantly lower VAS scores than the non-Deqi group （P＜0.01）. Compared to before treatment， the Deqi group exhibited significant activation in the prefrontal cortex （t = 6.28）， white matter （t = 6.36）， and left temporal lobe （t = 9.33）， while significant inhibition was observed in the occipital lobe （t = -9.86） and right cerebrum （t = -4.54， P＜0.01）； in the non-Deqi group， significant changes after treatment were observed in the left occipital lobe （t = -6.42）， left medial frontal gyrus （t = -4.35）， left middle frontal gyrus （t = -4.74）， right superior frontal gyrus （t = -4.82）， right superior temporal gyrus （t = -6.61）， and right cerebellar posterior lobe （t = -8.64）， all of which were in inhibited states （P＜0.01）. Compared to the non-Deqi group， the Deqi group exhibited significant activation after treatment in the external nucleus （t = 5.77）， white matter （t = 3.58）， right cerebrum （t = 5.84）， left cerebellum （t = 5.35）， and left cerebrum （t = 4.32）， while significant inhibition was observed in the prefrontal cortex （t = -4.16）， occipital lobe （t = -4.87）， and precentral gyrus （t = -4.46， P＜0.01）. ConclusionsHeat-sensitive moxibustion provides better analgesic effects for knee osteoarthritis under state of Deqi. Its central neuroregulation mechanism may be related to the involvement of the frontal lobe， temporal lobe， occipital lobe， external nucleus， white matter， right cerebrum， left cerebellum， left cerebrum， and precentral gyrus in modulating pain signals.

Femoral intertrochanteric fracture is one of the common types of fractures in the elderly. With the general improvement of medical and living standards, the number of elderly people is increasing, and the problem of osteoporosis has also become relatively prominent. Therefore, low violence can usually cause fractures in this area of the elderly, which has a significant negative impact on the quality of life of elderly patients. With the further development of medical technology and internal fixation materials, the emergence of proximal femoral nail antirotation(PFNA) has greatly improved the treatment effect of femoral intertrochanteric fractures in elderly patients. However, with the increasing number of patients treated, internal fixation failures have gradually been reported. In recent years, proximal femoral biomimetic intramedullary nail(PFBN) has been reported to have good clinical efficacy. Therefore, this article mainly elaborates on the theoretical basis, design characteristics, biomechanics, and clinical efficacy research of PFBN, providing more reference for the clinical treatment of femoral intertrochanteric fractures in elderly patients in the future.

AIM: To observe the changes of nerve fiber thickness and vessel density in macula and optic disc following femtosecond laser-assisted and conventional phacoemulsification cataract surgery through optical coherence tomography angiography(OCTA).METHODS: A total of 65 cases(85 eyes)that diagnosed with age-related cataract and received surgery in Aier Eye Hospital(East of Chengdu)were included in this prospective nonrandomized controlled study. The patients were divided into two groups according to the surgery choice, with 23 cases(30 eyes)in femtosecond laser assisted group, and 42 cases(55 eyes)in traditional phacoemulsification group. OCTA was used to compare the changes in central macular thickness, thickness of nerve fiber layer in optic disc, vessel density and blood perfusion preoperatively, and at 1 d and 1 mo postoperatively.RESULTS: BCVA of patients in the two groups was significantly improved and IOP was significantly reduced at 1 mo postoperatively(all P<0.01). The macular nerve fiber layer thickness of the femtosecond laser-assisted group was increased at 1 d and 1 mo postoperatively(all P<0.05), while there was no statistical difference in the traditional phacoemulsification group before and after surgery(all P>0.05); there were significant differences in nerve fiber layer thickness in optic disc, vessel density and blood perfusion in both macula and optic disc of the traditional phacoemulsification group(all P<0.05), but there were no differences in the femtosecond laser assisted group(all P>0.05). Furthermore, there were no significant differences in foveal avascular zone area in the two groups of patients(all P>0.05).CONCLUSION: Femtosecond laser-assisted cataract surgery had less impact on retinal vessels.

AIM: To evaluate clinical efficacy and safety of ultrasound cycloplasty(UCP)in the treatment of refractory glaucoma.METHODS:From June 2021 to October 2022, a total of 17 patients(17 eyes)with refractory glaucoma were enrolled in this prospective study, and they all underwent UCP. The patients underwent 6 mo followed-up post-treatment, and the intraocular pressure(IOP), pain grade score, IOP lowering drugs, success rate and occurrence of complications were documented.RESULTS:The IOP was significantly decreased from 51.98±7.80 mmHg before UCP to 32.54±13.21 mmHg at 1 d, 22.38±11.98 mmHg at 1 wk, 22.63±10.78 mmHg at 1 mo, 26.05±9.17 mmHg at 3 mo, and 23.73±9.60 mmHg at 6 mo postoperatively(all P<0.01). The percentage of IOP reduction after treatment was 36.25%, 57.10%, 56.35%, 49.16% and 54.09% at 1 d, 1 wk, 1, 3, and 6 mo, respectively. The pain grade scores were decreased(P<0.01). There was a statistically significant reduction in the use of IOP lowering medications(P=0.008). At 6 mo postoperatively, 2 eyes(12%)were complete success, 11 eyes(65%)were qualified success, and 4 eyes(24%)were failure. The main complication observed was anterior chamber inflammation in 1 eye(6%), foreign body sensation in 2 eyes(12%), subconjunctival hemorrhage in 2 eyes(12%), and conjunctival congestion in 6 eyes(35%). All symptoms spontaneously resolved within 1 wk without requiring any specific treatment. One case of choroidal detachment(6%)occurred on 10 d postoperatively, but recovered after orally treated by prednisone acetate for 1 mo. No other serious complications, such as hyphema, corectopia, synechia or macular edema were reported.CONCLUSION:UCP is safe and efficacious in treating refractory glaucoma, reducing IOP and alleviating ocular pain symptoms, while maintaining a favorable safety profile.

Objective:To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023.Methods:The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results:In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M( Q1, Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant ( χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age ( χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) ( χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions:RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Objective:To analyze the effects of SARS-CoV-2 infection and vaccination on virus mutation.Methods:The whole genome sequencing sequences of 2 659 local SARS-CoV-2 specimens from Jiangsu Province in 2023 were selected for analysis, and relevant information such as demographic and clinical characteristics were collected, and the effects of infection and vaccination on the genome-wide mutation rate and S gene′s selective pressure of the virus were analyzed by univariate and multivariate linear regression models.Results:The average age of these infected patients was 55.0 (31.0, 74.0) years, 1 150 cases (43.2%) in the age group of ≥60 years, 1 367 cases (51.4%) were males, 2 044 cases (76.9%) had a history of COVID-19 vaccination, and 1 629 cases (61.3%) had the first-time infection. The clinical symptoms of the infected patients were mainly mild, with a total of 2434 cases (91.5%), and 29 cases (1.1%) with severe symptoms or more. The average substitution rate of SARS-CoV-2 was 9.69 (9.38, 9.98)×10 -4 subs/site/year, and the dN/dS value of the S gene was 6.08 (5.56, 8.66), which was significantly greater than that of 1 ( P<0.001), indicating positive selection. The result of univariate and multivariate linear regression model analysis showed that the SARS-CoV-2 substitution rate was higher in those with vaccination history and reinfection, aged 20-30 years, ≥60 years, and the SARS-CoV-2 substitution rate was lower in males with moderate clinical symptoms and severe disease and above. Those with a history of vaccination and reinfection, aged 50-60 years old, ≥60 years old have smaller S gene dN/dS. Conclusions:Under the immune pressure exerted by vaccination and infection, the genome-wide mutation of SARS-COV-2 accelerated, but the non-synonymous mutation rate of the S gene decreased. The mechanism causing these phenomena needs further study.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Objective:To develop an integrated point-of-care testing (POCT) reagent for genotying respiratory syncytial virus (RSV) and evaluate its performance.Methods:Specific primers and probes were designed based on the conserved sequences of the genomes of RSV A and B as well as ON1 and BA9 genotypes. The PCR reaction system and conditions were optimized. The vitrification technology of reagents and multiplex detection platform were integrated to develop the RSV genotyping POCT reagent. The sensitivity, specificity, reproducibility, and clinical performance of the product were then evaluated.Results:The sensitivity of the developed integrated RSV genotyping POCT reagent reached 500 copies/ml. It exhibited good specificity with no cross-reaction with clinically similar pathogens. The coefficient of variation of Ct values for both inter-batch and intra-batch reproducibility was less than 5%, indicating good reproducibility. In testing 53 clinical samples, the detection results showed high consistency and concordance with the reference reagent, with a positive concordance rate of up to 98.11%.Conclusions:The developed integrated RSV genotyping POCT reagent incorporates nucleic acid extraction, purification, and detection into a single process, achieving a "sample in, result out" workflow. It is simple to operate and provides accurate, reliable, and stable detection results. This product can be used for the genotyping of RSV A and B in POCT, offering support for the prevention, control, and diagnosis of RSV.

Objective:To investigate the clinical effects of the modified posteromedial approach combined with the anterolateral approach in the treatment of posterior pilon fractures in the supine position.Methods:A retrospective was conducted to analyze the clinical data of 54 patients [45 males and 9 females with an age of (47.7 ± 13.1) years] who had been treated surgically for posterior pilon fractures from January 2016 to December 2020 at Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into 2 groups according to their surgical positions: a supine group of 24 patients (the modified posteromedial approach combined with the anterolateral approach in the supine position) and a prone group of 30 patients (the posteromedial approach combined with the anterolateral approach in the prone position). The 2 groups were compared in terms of operation time, hospitalization time, radiographic outcomes (bone union time and ratio of congruent articular reduction), range of ankle motion, and postoperative complications. The post-operative function was evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ) and the visual analogue scale (VAS).Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The mean follow-up time was (19.4 ± 4.4) months for the supine group and (17.8 ± 4.2) months for the prone group. The operation time, hospitalization time, bone union time, rate of fixation of syndesmosis and ratio of congruent articular reduction were (90.8 ± 9.9) min, (9.5 ± 2.4) d, (8.4 ± 1.4) weeks, 33.3% (8/24) and 95.8% (23/24) in the supine group, and (89.1 ± 10.8) min, (9.5 ± 2.5) d, (8.1 ± 1.4) weeks, 53.3% (16/30) and 96.6% (29/30) in the prone group, showing no significant differences (all P>0.05). At the last follow-up, the dorsiflexion and plantar flexion of the ankle, VAS, and MOXFQ scores for pain, walking and social capability were, respectively, 15.0° ± 2.1°, 26.1° ± 4.2°, (1.0 ± 0.5) points, 20.0(0, 30.0) points, (16.5 ± 13.2) points and 12.5(0, 18.8) points in the supine group, and 15.7° ± 1.6°, 27° ± 4.0°, (1.3 ± 0.7) points, 12.5(10.0, 30.0) points, (19.0 ± 11.5) points and 15.6(6.3, 25.0) points in the prone group, showing no significant differences ( P>0.05). The total incidence of complications was 8.3% (2/24) in the supine group and 3.3% (1/30) in the prone group, showing no significant difference either ( P>0.05). Conclusion:In the treatment of posterior pilon fractures, as the modified posteromedial approach combined with the anterolateral approach in the supine position is equivalent to the posteromedial and the posterolateral approaches in the prone position in terms of reduction quality, bone union time, functional outcomes and complications, it can be used as an alternative choice.