Objective:To explore the clinical efficacy of the San Diego osteotomy in treating developmental dysplasia of the hip (DDH) in children.Methods:A retrospective analysis was conducted on 33 pediatric cases of posterolateral acetabular dysplasia treated with the San Diego osteotomy at the 920th Hospital of the People's Liberation Army Joint Logistics Support Force in China from August 2018 to August 2022. The cohort included 3 males (4 hips) and 30 females (36 hips), with an average age of 4.9±1.4 years (range, 2-8 years). Among these, 32 cases (38 hips) were diagnosed with DDH, and 1 case (2 hips) with paralytic dislocation of the hip. According to the T?nnis classification, 3 hips were classified as type II, 25 hips as type III, and 12 hips as type IV. The San Diego osteotomy technique was utilized to enhance the posterior lateral acetabular coverage, combined with femoral osteotomy to adjust the hip abduction, flexion, and adduction angles. Postoperative outcomes were assessed using the modified Severin radiographic classification and the McKay grading system.Results:All 33 patients were followed up for an average of 37.70±18.44 months (range, 12-74 months). No cases of postoperative hip redislocation or residual acetabular underdevelopment were observed. The hip abduction angle improved from 24.98°±3.48° at 6 weeks postoperatively to 37.28°±4.63° at the 3-month follow-up, and 64.05°±3.82° at the 6-month follow-up, with a statistically significant difference ( F=77.327, P<0.001). The hip flexion angle increased from 26.34°±5.05° at 6 weeks postoperatively to 76.53°±4.38° at 3 months, and 106.47°±2.29° at 6 months, also showing a statistically significant difference ( F=54.377, P<0.001). The hip adduction angle progressed from 1.73°±1.18° at 6 weeks postoperatively to 12.33°±1.97° at 3 months, and 29.03°±4.17° at 6 months, with a significant difference ( F=45.162, P<0.001). The McKay hip joint grading system indicated 11 excellent, 20 good, and 9 acceptable outcomes, yielding an overall excellent and good rate of 78%. The Severin radiographic grading revealed 16 hips at grade I and 24 hips at grade II. Five patients (5 hips) experienced transient vascular compromise of the femoral head at 3 months postoperatively, which resolved after a 1-month non-weight-bearing period. At the final follow-up, one patient had residual femoral head enlargement in the right hip, while the remaining 32 cases showed satisfactory ossification and remodeling of the femoral head. Conclusion:The San Diego osteotomy significantly enhances hip joint range of motion and results in satisfactory hip joint function in children with developmental dysplasia of the hip

Pelvic floor muscle training (PFMT) is the first-line intervention for non-surgical treatment of female patients with stress urinary incontinence (SUI). However, due to the particularity of the physiological position of the pelvic floor muscles, 13% to 53% of patients are unable to perform PFMT correctly after the initial visit. In view of this, scholars at China and abroad put forward some other sports rehabilitation methods and achieve good clinical results. In this paper, exercise rehabilitation methods for female SUI patients were reviewed, including PFMT, core muscle training, Pilates, yoga, physical activities, etc., in order to provide reference for medical personnel to formulate scientific and feasible exercise rehabilitation programs for female SUI patients.

Objective:To investigate the short-term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head (SIFFH) in young and middle-aged people.Methods:A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH, who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022. The patients included 10 males and 3 females, aged 22-49 years [(33.5±8.3)years]. There were 6 patients with fracture on the left hip and 7 on the right hip. All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament. Postoperatively, standardized joint functional training was given. The operative time and intraoperative bleeding were recorded. The modified Harris hip score and visual analogue score (VAS) were compared preoperatively, at 3, 6 months postoperatively and at the final follow-up. Radiological examinations were used to observe the occurrence of any collapse of the femoral head, non-union at osteotomy site or other complications.Results:The patients were followed up for 13-24 months [(17.9±3.1)months]. The operative time was (127.3±9.8)minutes, with the intraoperative bleeding of (393.9±21.9)ml. The values of modified Harris hip score were (61.6±3.3)points, (80.2±4.4)points, and (91.9±4.1)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly higher than the preoperative (51.4±3.5)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). The values of VAS were (4.9±1.1)points, (3.0±0.9)points, and (1.4±0.5)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly lower than preoperative (6.7±0.9)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). Imaging examination showed no femoral head collapse, with all the bones healed at the osteotomy site. There were no serious complications such as bone non-union, incision infection or peripheral nerve injury. Conclusion:Rotational femoral neck osteotomy with preservation of the round ligament in treating SIFFH in the young and middle-aged population has the advantages of shortened operative time, less intraoperative bleeding, promoted hip function recovery, attenuated pain and decreased complications, showing a satisfactory early effect.

Objective:To investigate the self-measured health status of college students in Tibet, and to construct the self-measured health scale (SRHMS V1.0) norm of College students in Tibet.Methods:This was a cross-sectional study. A multistage stratified sampling method was used. From April to June 2022, a total of 7 990 college students were selected from all colleges and universities in the Tibet Autonomous Region (7 in total). The self-rated health of Tibetan college students was investigated and evaluated by combining demographic information and SRHMS V1.0. Descriptive statistics, t-test, analysis of variance ( Brown-Forsythe test for unequal variance, LSD test for multiple comparisons), and Spearman correlation analysis were used to construct mean norm, percentile norm, and delimitation norm of physiological scale health (PSH), mental scale health (MSH), social scale health (SSH) score and total scale health (TSH) scores. Results:The total score of self-assessed health assessment among college students in Tibetan universities was (72.18±12.35). For different genders, the PSH, MSH, SSH and TSH scores were (73.85±13.78), (65.80±14.73), (69.85±16.00) and (73.44±12.77) for boys and (71.18±13.36), (62.81±14.03), (68.57±14.90) and (70.92±11.94) for girls, respectively. Scores on each subscale and total scale were statistically significant different between the different sexes ( t=2.531, 2.672, 1.867, 2.623, all P<0.05). For different grades, the PSH, MSH, SSH and TSH scores of the freshman were (73.36±13.23), (65.77±14.58), (70.98±15.60) and (73.51±11.91); the sophomore were (70.74±13.73), (62.40±13.60), (66.92±14.62) and (70.16±12.28), the junior were (75.48±13.09), (64.08±15.12), (71.90±15.12) and (74.10±12.36); and the senior were (67.21±14.41), (59.19±17.67), (64.91±18.59) and (66.94±14.59) respectively, with the differences in scores of each subscale and the total scale in different grades being statistically significant ( F=3.952, 3.611, 4.841, 5.583, all P<0.05). The mean norm, percentile norm and demarcation norm of the total score and each subscale of self-measured health of college students in Tibetan universities were constructed with gender and grade as the cut-off values. Conclusion:The model of self-measured health assessment scale for students in colleges and universities in Tibet is established, which can provide evaluation criteria for evaluating the health status of college students in Tibet and plateau areas.

Objective:To construct a real-time artificial intelligence (AI)-assisted endoscepic diagnosis system based on YOLO v3 algorithm, and to evaluate its ability of detecting focal gastric lesions in gastroscopy.Methods:A total of 5 488 white light gastroscopic images (2 733 images with gastric focal lesions and 2 755 images without gastric focal lesions) from June to November 2019 and videos of 92 cases (288 168 clear stomach frames) from May to June 2020 at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University were retrospectively collected for AI System test. A total of 3 997 prospective consecutive patients undergoing gastroscopy at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University from July 6, 2020 to November 27, 2020 and May 6, 2021 to August 2, 2021 were enrolled to assess the clinical applicability of AI System. When AI System recognized an abnormal lesion, it marked the lesion with a blue box as a warning. The ability to identify focal gastric lesions and the frequency and causes of false positives and false negatives of AI System were statistically analyzed.Results:In the image test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 92.3% (5 064/5 488), 95.0% (2 597/2 733), 89.5% (2 467/ 2 755), 90.0% (2 597/2 885) and 94.8% (2 467/2 603), respectively. In the video test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 95.4% (274 792/288 168), 95.2% (109 727/115 287), 95.5% (165 065/172 881), 93.4% (109 727/117 543) and 96.7% (165 065/170 625), respectively. In clinical application, the detection rate of local gastric lesions by AI System was 93.0% (6 830/7 344). A total of 514 focal gastric lesions were missed by AI System. The main reasons were punctate erosions (48.8%, 251/514), diminutive xanthomas (22.8%, 117/514) and diminutive polyps (21.4%, 110/514). The mean number of false positives per gastroscopy was 2 (1, 4), most of which were due to normal mucosa folds (50.2%, 5 635/11 225), bubbles and mucus (35.0%, 3 928/11 225), and liquid deposited in the fundus (9.1%, 1 021/11 225).Conclusion:The application of AI System can increase the detection rate of focal gastric lesions.

ObjectiveTo analyze the characteristics of HIV-1 subtypes and drug-resistance mutation sites among HIV-infected patients who received high-efficiency antiretroviral therapy but failed. MethodsA total of 130 plasma samples were collected from the patients who received antiviral treatment for 6 months in Taizhou City of Zhejiang Province in 2021 but failed the treatment and the viral load was ≥1 000 copies·mL^-1. Nucleic acid in the samples was extracted， and the pol gene was amplified by nested reverse transcription PCR. After next-generation sequencing， online tools were used to compare and analyze the subtypes and drug-resistant mutation sites. ResultsA total of 110 samples were successfully sequenced. The main HIV-1 subtype was CRF01_AE， accounting for 42.72% （47 cases）， followed by CRF07_BC， 35.45% （39 cases）； CRF08_BC， 10.00% （11 cases）； CRF85_BC ， 8.18% （9）； and a small number of B subtype， 1.81% （2 cases） and C subtype， 1.81% （2 cases）. The online tool comparison showed that there were 67 cases with mutations of drug-resistance sites and 61 cases with drug-resistance. The mutation sites were mainly M184V， K103N， K65R and V181C， and the mutation rates were 20.00% （22 cases）， 10.91% （12 cases）， 8.18% （9 cases） and 8.18% （9 cases）， respectively. These mutation sites caused different degrees of resistance to nucleoside reverse transcriptase inhibitors （NRTI）， non- nucleoside reverse transcriptase inhibitors （NNRTI） and protease inhibitors （PI）， including 45 cases of NRTI， 61 cases of NNRTI and 2 cases of PI resistance. ConclusionThe HIV infected people who fail the treatment in Taizhou are mainly with the subtypes CRF01_AE and CRF07_BC. The rate of drug-resistance mutation is at a moderate level， mainly due to the mutation of NRTI and NNRTI drug-resistance sites， and a small number of PI drug-resistance sites. Therefore， the antiviral treatment plan for HIV infected people should be reasonably adjusted， and the detection of drug-resistance mutation sites should be strengthened to avoid the generation of transmissible drug-resistance strains.

The infectious disease outpatient service as a frontier is an important fulcrum of public health service. Its standardized construction is an important support for ensuring medical safety, reducing nosocomial infections, and controlling the epidemic of infectious diseases. The sub-specialty outpatient service of infection diseases includes fever outpatient service, intestinal outpatient service, tuberculosis outpatient service, AIDS outpatient service, liver disease outpatient service, etc. According to the characteristics of each subspecialty outpatient service and combining with clinical practice, we elaborated the setting norms of subspecialty outpatient service for common infectious diseases from the perspective of planning and design, building layout, equipment and facilities configuration, staffing, daily management and demonstration.

Objective:To explore and optimize the management process of bladder irrigation for patients after greenlight photoselective vaporization (PVP) , reduce the occurrence of postoperative complications, and improve the satisfaction of patients and nurses for bladder irrigation.Methods:Totally 315 patients undergoing PVP in the Department of Urinary Surgery, the Second Hospital of Hebei Medical University from May 2017 to April 2019 were selected using purposive sampling. A total of 153 patients admitted from May 2017 to April 2018 were divided into the control group, who received routine bladder irrigation management, while 162 patients admitted from May 2018 to April 2019 were divided into the observation group, who received bladder irrigation management by the failure mode and effect analysis. The incidence of complications such as bladder spasm and urinary tract obstruction, the duration of continuous bladder irrigation, and patient satisfaction were compared between the two groups, and the nurse satisfaction before and after the process optimization was compared.Results:After the process optimization, the incidence of bladder spasm decreased from 17.0% (26/153) to 8.0% (13/162) , the incidence of urinary tract obstruction decreased from 11.8% (18/153) to 3.7% (6/162) , and the differences were statistically significant (χ 2=5.835, 7.264; P<0.05) . The duration of bladder irrigation was shortened from (25.311±2.295) h to (22.422±1.481) h, and the difference was statistically significant ( t=13.348, P<0.05) . After optimizing the bladder irrigation management process, the nurse satisfaction score was (34.221±5.124) , and the patient satisfaction score was (37.113±6.108) , both higher than those before the optimization, and the differences were statistically significant ( t=19.817, 14.546; P<0.05) . Conclusions:Optimizing the bladder irrigation management process for patients after PVP using the failure mode and effect analysis can reduce the incidence of postoperative bladder irrigation complications, shorten the duration of bladder irrigation, and improve patient and nurse satisfaction.

OBJECTIVETo discuss the clinical therapeutic effects of electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) on the analgesic effect of thoracic perioperative stage and its effect mechanism.

METHODSSixty cases of esophageal cancer with elective radical resection under general anesthesia were divided into an observation group and a control group according to the operation sequence, 30 cases in each one. In the control group, the general anesthesia was simply applied and sufentanil was administered for patient controlled intravenous analgesia (PCIA) after operation. In the observation group, on the basis of the scheme as the control group, the electroacupuncture was used at Neimadian (Extra) and Neiguan (PC 6) 30 min before anesthesia induction and after operation, with continuous wave, tolerable intensity, lasting for 30 min. Separately, before acupuncture (T1) and 2h (T2), 12h (T3), 24h (T4) and 48h (T5) after operation, the plasma β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E(PGE) were determined. During operation, under the same state (from 50 to 60) of bispectrum of EEG (BIS), the intraoperative anesthetic dose was recorded. Using visual analogue scale (VAS), the pain degree was evaluated at T2, T3, T4 and T5 separately and the grade assessment of the therapeutic effects and safety were recorded at each time point.

RESULTS①The total dosage of sufentanil in the observation group was less than that in the control group[(1.83±0.56) mg vs (2.54±0.62) mg,<0.05]. ②VAS scores at T2, T3 and T4 in the patients of the observation group were all lower than those in the control group (all<0.05). ③The levels of plasma β-EP at T3, T4 and T5 in the observation group were increased significantly as compared with those in the control group (all<0.05) and the levels of plasma 5-HT and PGEat T2, T3 and T4 were reduced significantly as compared with those in the control group (all<0.05). ④ The excellent analgesia rates 2h、12h and 24h after operation in the observation group were better than those in the control group (all<0.05). ⑤The rate of the A grade safety in the observation group was higher than that in the control group (<0.05).

CONCLUSIONSElectroacupuncture at Neimadian (Extra) and Neiguan (PC 6) provides the safe and effective postoperative anesthesia of thoracic surgery and reduces the dosage of analgesics during the operation, which is possibly related to the increase of endogenous β-EP and the inhibition on the release of 5-HT and PGE.

Objective:To establish a database for pelvic trauma in Hunan Province,and to start the work of multicenter pelvic trauma registry.Methods:To establish the database,literatures relevant to pelvic trauma were screened,the experiences from the established trauma database in China and abroad were learned,and the actual situations for pelvic trauma rescue in Hunan Province were considered.The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6.Results:The complex procedure for pelvic trauma rescue was described structurally.The contents for the database included general patient information,injurious condition,prehospital rescue,conditions in admission,treatment in hospital,status on discharge,diagnosis,classification,complication,trauma scoring and therapeutic effect.The database can be accessed through the internet by browser/servicer.The functions for the database include patient information management,data export,history query,progress report,video-image management and personal information management.Conclusion:The database with whole life cycle pelvic trauma is successfully established for the first time in China.It is scientific,functional,practical,and user-friendly.