ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

Objective:To investigate the clinical efficacy of hip arthroscopy in the treatment of acetabular labral injury combined with cysts.Methods:A total of 14 patients (5 males and 9 females) aged 35.46±12.62 years (range, 26-57 years) with acetabular labral injury complicated with cyst who underwent hip arthroscopy in Department of Sports Injury and Arthroscopy, Tianjin Hospital from January 2017 to April 2022 were retrospectively analyzed. There were 8 cases of left hip and 6 cases of right hip with an average body mass index of 24.35±3.14 kg/m 2 (range, 20.2-28.4 kg/m 2). The duration of symptoms was 6.25±4.39 months (range, 3-11 months). All patients underwent hip arthroscopic cyst cleaning and glenoid labral suturing. The femoral neck α angle, lateral center rim angle, visual analogue score (VAS), Harris hip score (HHS), and international hip outcome tool scores (iHOT-12) were compared before and after operation. Results:All patients successfully completed the operation and were followed up for 10.23±2.45 months (range, 1.5-18 months). The difference between the patients' hip VAS before and after operation was statistically significant ( F=108.47, P<0.001). The VAS score at 18 months after operation was 1.34±0.83, which was significantly lower than that before operation 7.85±1.12 and at 6 weeks after operation 5.03±1.60 ( P<0.05). The difference between the patients' hip HHS scores before and after operation was statistically significant ( F=96.89, P<0.001). The HHS score at 18 months after operation was 85.58±4.65, which was significantly higher than that before operation 54.36±2.31 and 6 weeks after operation 61.12±1.20 ( P<0.05). The differences of iHOT-12 scores before and after operation were statistically significant ( F=117.92, P<0.001). The iHOT-12 score of 18 months after operation was 78.36±2.28 points, which was higher than that before operation 31.39±5.21 points and 6 weeks after operation 47.88±2.20 points, and the difference was statistically significant ( P<0.05). The difference of α angle of femoral neck before and after operation was statistically significant ( F=101.56, P<0.001). The α angle of femoral neck at 12 months after operation was 45.32°±3.16°, which was significantly lower than that before operation 50.86°±8.41° ( P<0.05). The difference of lateral center rim angle before and after operation was statistically significant ( F=100.38, P<0.001). The lateral center rim angle was 28.23°±5.32° at 12 months after operation, which was smaller than that before operation 32.16°±5.13°, and the difference was statistically significant ( P<0.05). Conclusion:Hip arthroscopy in the treatment of acetabular labral injury with cysts can relieve hip pain and improve hip function.

Objective     To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods     China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results     A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery  significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion     The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.

Ulcerative colitis(UC)is a chronic inflammatory bowel disease caused by many factors including colonic inflammation and microbiota dysbiosis.Previous studies have indicated that celastrol(CSR)has strong anti-inflammatory and immune-inhibitory effects.Here,we investigated the effects of CSR on colonic inflammation and mucosal immunity in an experimental colitis model,and addressed the mechanism by which CSR exerts the protective effects.We characterized the ther-apeutic effects and the potential mechanism of CSR on treating UC using histological staining,intestinal permeability assay,cytokine assay,flow cytometry,fecal microbiota transplantation(FMT),16S rRNA sequencing,untargeted metabolomics,and cell differentiation.CSR administra-tion significantly ameliorated the dextran sodium sulfate(DSS)-induced colitis in mice,which was evidenced by the recovered body weight and colon length as well as the decreased disease activity index(DAI)score and intestinal permeability.Meanwhile,CSR down-regulated the production of pro-inflammatory cytokines and up-regulated the amount of anti-inflammatory mediators at both mRNA and protein levels,and improved the balances of Treg/Thl and Treg/Th1 7 to maintain the colonic immune homeostasis.Notably,all the therapeutic effects were exerted in a gut microbiota-dependent manner.Furthermore,CSR treatment increased the gut microbiota diversity and changed the compositions of the gut microbiota and metabolites,which is probably associated with the gut microbiota-mediated protective effects.In conclusion,this study provides the strong evidence that CSR may be a promising therapeutic drug for UC.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective:To evaluate and quantify the degree of language impairment by obtaining the cerebral blood flow in the main language functional areas of aphasia patients after stroke with arterial spin labeling sequence, so as to make aphasia evaluation more objectively, accurately and effectively.Methods:From May 2016 to October 2019, 22 patients with aphasia after stroke and 22 healthy controls were collected from the Department of Neurology, the First Affiliated Hospital of Zhejiang University, for multimode MR scanning, and the patients were evaluated by aphasia scale during hospitalization. The classic language related brain area and potential language related brain area were selected as the regions of interest to extract the local mean cerebral blood flow. The differences of cerebral blood flow between the two groups were compared, and the correlation between the cerebral blood flow of each region of interest and the sub items of multiple language scales was analyzed.Results:Compared with the control group, the cerebral blood flow of the inferior parietal gyrus （AAL-11，(39.18±3.85) ml·100 g -1·min -1vs (50.41±1.93) ml·100 g -1·min -1， t=2.605）, angular gyrus （AAL-13，(39.90±3.29) ml·100 g -1·min -1vs (47.86±1.93) ml·100 g -1·min -1, t=2.087） in the patients was obviously decreased; In the relevant brain areas of listening comprehension, the cerebral blood flow of the inferior parietal gyrus (AAL-61, (33.86±4.15) ml·100 g -1·min -1vs (44.31±2.39) ml·100 g -1·min -1, t=2.179), superior marginal gyrus (AAL-63, (36.49±4.40) ml·100 g -1·min -1vs（50.17±2.26） ml·100 g -1·min -1, t=2.765), and angular gyrus (AAL-65, (35.56±4.24) ml·100 g -1·min -1vs(48.98±2.32) ml·100 g -1·min -1, t=2.777), Heschl gyrus (AAL-79, (47.30±5.11) ml·100 g -1·min -1vs（62.54±2.45） ml·100 g -1·min -1, t=2.689) and superior temporal gyrus (AAL-81, (43.56±4.82) ml·100 g -1·min -1vs (56.29±2.06) ml·100 g -1·min -1, t=2.429) of the patients was also decreased to different degrees ( P<0.05). In addition, the cerebral blood flow of the left insula (AAL-29, (46.59±3.76) ml·100 g -1·min -1vs (55.74±2.12) ml·100 g -1·min -1, t=2.120) and the rolandic island (AAL-17, (39.71±3.81) ml·100 g -1·min -1vs (52.48±2.01) ml·100 g -1·min -1, t=2.968)cover in the patients was also lower than that in the control group significantly ( P<0.05). The results of correlation analysis showed that there was a significant positive correlation ( P<0.05) between the brain blood flow of the left inferior frontal gyrus, the triangle of inferior frontal gyrus, the insular lobe, the inferior parietal lobe, the bilateral superior marginal gyrus and the sub item scores of the language scale in the patients. Conclusions:The decrease of cerebral blood flow is the potential cause of the decrease of language function in aphasia patients after stroke. The decrease of cerebral blood flow in six brain regions, including the frontal inferior gyrus, the frontal inferior gyrus triangle, the insular lobe, the left and right superior marginal gyrus and the inferior parietal lobe, can be used as an objective quantitative index to reflect the level of naming function.

The epidemiological history and clinical characteristics of 7 cases of COVID-19 and 1 case of close contact in the first family aggregation epidemic of COVID-19 in Gansu Province were analyzed. The first patient A developed on January 22, 2020, with a history of residence in Wuhan, and confirmed severe cases of NCP on January 24, 2020; patient B, on January 23, 2020, diagnosed on January 31, severe cases; patient C, asymptomatic, diagnosed on January 27; patient D, asymptomatic, diagnosed on January 27; patient E, on January 24, diagnosed on January 28; patient F, asymptomatic, diagnosed on January 31; Patient G was asymptomatic and was diagnosed on January 31. In close contact, H was asymptomatic, PCR test was negative and asymptomatic, and he was discharged early. Among the 7 patients, 1 case died of (B) aggravation, and the other patients' condition was effectively controlled after active treatment. Except for the discharged cases, 5 cases were positive for COVID-19 specific IgM antibody and 1 case was negative. In this clustering outbreak, 4 patients remained asymptomatic, but PCR and IgM antibodies were positive, indicating that asymptomatic patients may be the key point to control the epidemic. Specific IgM antibody screening for patients whose pharyngeal swab nucleic acid test is negative but with ground glass-like lung lesions is very important for early detection and early isolation.

The epidemiological history and clinical characteristics of 7 cases of COVID-19 and 1 case of close contact in the first family aggregation epidemic of COVID-19 in Gansu Province were analyzed. The first patient A developed on January 22, 2020, with a history of residence in Wuhan, and confirmed severe cases of NCP on January 24, 2020; patient B, on January 23, 2020, diagnosed on January 31, severe cases; patient C, asymptomatic, diagnosed on January 27; patient D, asymptomatic, diagnosed on January 27; patient E, on January 24, diagnosed on January 28; patient F, asymptomatic, diagnosed on January 31; Patient G was asymptomatic and was diagnosed on January 31. In close contact, H was asymptomatic, PCR test was negative and asymptomatic, and he was discharged early. Among the 7 patients, 1 case died of (B) aggravation, and the other patients' condition was effectively controlled after active treatment. Except for the discharged cases, 5 cases were positive for COVID-19 specific IgM antibody and 1 case was negative. In this clustering outbreak, 4 patients remained asymptomatic, but PCR and IgM antibodies were positive, indicating that asymptomatic patients may be the key point to control the epidemic. Specific IgM antibody screening for patients whose pharyngeal swab nucleic acid test is negative but with ground glass-like lung lesions is very important for early detection and early isolation.

Objective Toevaluatetheclinicalvalueofmagneticresonanceenterography (MRE)indiagnosingCrohn’sdisease (CD).Methods ThearticlesconcerningthediagnosisofCD byusing MRE weresystematicallysearchedindatabasesincluding PubMed,EMbase,CochraneLibrary,WebofScience,CNKI,CBM,WanFangandVIPdata.Tworeviewersindependentlyscreenedliterature, extracteddata,andassessedbiasriskofincludedstudiesbyusingtheQUADAS-2.Then,thisMeta-analysiswasperformedbyusing Stata12.0software.Thepooledweightedsensitivity,specificity,positivelikelihoodratio(PLR),negativelikelihoodratio (NLR)and diagnosticoddsratio(DOR)werecalculated,thesummaryreceiveroperatingcharacteristiccurve(sROC)wasdrawnandtheAUC wascalculated.Results Atotalof16studieswereincluded,involving1276patientsand919bowelsegments.TheresultsofMeta-analysisshowed that,thepooledsensitivity,specificity,PLR,NLR,DORandAUCofMREdiagnosingCDwere0.87(95%CI:0.79,0.92),0.92(95%CI:0.89, 0.94),10.6(95%CI:7.4,15.2),0.15(95%CI:0.09,0.24),72.69(95%CI:32.7,161.51),0.95(95%CI:0.93,0.97),respectively.Theresultsof subgroupanalysissuggestedthat,thestudytype,MRT-field,pathogenicsiteanddiagnosticcriteriaplayedlittleeffectonthevalueof MREdiagnosingCD (P>0.05).Conclusion MREhadhigheraccuracyfordiagnosingCDand mayservedasanefficientimaging methodfordiagnosingCD.

Objective To study the role of interictal epileptiform discharge (IED) in reducing recurrent epilepsy after withdrawal of antiepileptic drugs (AED).Methods One hundred epilepsy pa tients with no seizure for ≥2 years were divided into IED group (n=51) and IED free group (n=49) according to the classification of epilepsy seizure developed by the International Association for the Prevention of Epilepsy in 1981.The patients were further divided into elderly group (n=21) and non-elderly group (n=79) and were followed up for at least 1 year by return visit or telephone.Results No significant difference was found in the incidence of IED in the 100 epilepsy patients with different types of seizure,such as myospasm,simple partial seizure and ≥2 seizures.However,the incidence of IED was significantly higher than that of myotonia,myospasm,absence and simple partial seizure (P＜0.05).Epilepsy recurred in 37 patients (72.5％) of IED group and in 16 patients (32.7％) of IED-free group.Logistic regression analysis showed that the course of epilepsy and IED were the risk factors for recurrent epilepsy after withdrawal of AED (OR=1.165,95％CI:1.022-1.329,P=0.022;OR=2.794,95％CI:1.040-7.509,P=0.042) and the course of epilepsy was longer in elderly group than in non-elderly group (10.10±7.55 years vs 5.97±4.04 years,P=0.001).Conclusion The seizure type and course of epilepsy are the relia ble predictors of recurrent epilepsy in patients with no seizure for a long time after withdrawal of AED,and are thus of clinical significance.