Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

Objective:To investigate the clinical efficacy of 3D printed metal augment or tibial prosthesis for reconstruction of large bone defects in total knee arthroplasty (TKA) and knee revision surgery.Methods:A total of 7 patients (7 knees) with TKA or knee revision who were admitted to the Department of Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine with large bone defects from July 2018 to December 2023 were retrospectively analyzed, including 4 patients with TKA and 3 patients with knee revision. There were 3 males and 4 females, aged 58.7±7.6 years (range, 54-68 years), 3 patients with left knee and 4 patients with right knee. All the patients had bone defects in the knee joint (AORI type III), 2 cases had bone defects only in the femur, 4 cases had bone defects only in the tibia, and 1 case had bone defects in both the tibia and femur, which were treated with personalized reconstruction using 3D printing. Hip-knee-ankle angles, American Knee Society score (KSS) before and after surgery were compared, and postoperative complications were observed.Results:All patients successfully completed the operation, and the operation time was 189.3±35.5 min (range, 125-240 min). Complex TKA was performed in 4 cases with surgical times of 175, 195, 210, and 240 min, and revision surgery was performed in 3 cases with surgical times of 125, 180, and 200 min, respectively. Intraoperative blood loss was 114±24.4 ml (range, 100-150 ml). Five cases used 3D printed metal augment, and two used 3D printed one-piece tibial components. All patients were followed up for 2, 2, 5, 6, 7, 20, 57 months, respectively. The KSS of the five patients at 3 months postoperatively were 56, 61, 66, 56, and 56 points, respectively, greater than the preoperative scores of 35, 44, 36, 27, and 41 points. The KSS functional scores of the five patients at 3 months postoperatively were 45, 45, 45, 30, and 45 points, respectively, which were greater than the preoperative scores of 30, 30, 15, 20, and 20 points. The hip-knee-ankle angle was 181.8°±3.4° (range, 177.9° to 188.0°) at the final follow-up and 175.8°±12.4° (range, 153.3° to 192.1°) before surgery, with no significant difference ( t=-1.230, P=0.242). At the final follow-up, the 3D printed component was well integrated with the bone surface, the prosthesis was securely positioned, and the force lines of the lower limbs were normal. There were no postoperative complications such as poor wound healing, infection, fat liquefaction, nerve injury, deep vein thrombosis of lower limbs, knee joint stiffness, periprosthesis infection and loosening. Conclusion:Using 3D printed metal augment or tibial prosthesis to reconstruct the huge bone defect in TKA and revision has a satisfactory early clinical effect, satisfactory joint function and good surgical safety.

Objective To construct a rehabilitation care platform for spinal cord injury patients,based on patient portrait technology and to validate its application effect.Methods Artificial intelligence technology was used to realize the fusion of data.We constructed a patient portrait rehabilitation nursing system that can provide systematic and personalized information support.By the convenience sampling method,53 perioperative patients with spinal cord injury from July 2023 to December 2023 were selected as the test group to implement the intelligent intervention based on patient portrait technology;53 perioperative patients with spinal cord injury who were hospitalized from January 2023 to June 2023 were selected as the control group to implement the conventional information support intervention.The self-efficacy,self-care ability,and quality of life were compared before the intervention,and 2 weeks,4 weeks,12 weeks after the intervention between the 2 groups.Results 45 cases in the experimental group and 43 cases in the control group reached the endpoint of the study after 12 weeks of intervention.The ANOVA of the 2 groups showed the test group having a greater advantage over the control group,with statistically significant differences in self-efficacy,ability to perform daily living tasks,and quality of life between groups,intergroup effect,and interaction effect(P＜0.05).Conclusion The rehabilitation care platform based on patient portraits has a positive effect on improving self-efficacy,self-care ability and quality of life for spinal cord injury patients.

Objective:To analyze the effects of basic treatment of periodontal diseases combined with orthodontic treatment on periodontal pocket depth and bleeding index (BI) in patients with anterior tooth displacement caused by periodontal diseases.Methods:A total of 136 patients with anterior tooth displacement due to periodontal disease treated in the Second People′s Hospital of Yueqing from October 2020 to October 2022 were enrolled and they were divided into two groups by random number table method, and each group with 68 cases. The control group was given basic treatment for periodontal disease, while the experimental group was combined with orthodontic treatment on the basis of the control group. The clinical efficacy, masticatory efficiency, periodontal pocket depth (PD), probing BI, gingival sulcus inflammatory factors and the total incidence of complications were compared between the two groups.Results:The total effective rate in the experimental group was higher than that in the control group: 95.59%(65/68) vs. 79.41%(54/68), there was statistical difference ( P<0.05). After treatment for 3 months, the masticatory efficiency in the experimental group was higher than that in the control group, and PD, BI in the experimental group were lower than that in the control group: (70.52 ± 6.88) % vs.(61.52 ± 4.04) %, (2.12 ± 0.62) mm vs. (3.18 ± 0.85) mm, (1.26 ± 0.26) scores vs. (2.42 ± 0.33) scores, there were statistical differences ( P<0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-8 in the experimental group were lower than those in the control group: (11.16 ± 1.85) μg/L vs. (16.92 ± 2.84) μg/L, (8.16 ± 1.34) ng/L vs. (15.49 ± 2.74) ng/L, (6.18 ± 1.46) ng/L vs. (10.33 ± 1.75) ng/L, there were statistical differences ( P<0.05). The total complication rate in the experimental group was lower than that in the control group: 1.47%(1/68) vs. 11.76%(8/68), there was statistical difference ( P<0.05). Conclusions:Basic treatment of periodontal diseases combined with orthodontics can effectively improve the masticatory efficiency of patients with anterior tooth displacement caused by periodontal diseases, reduce PD,BI and alleviate gingival sulcus inflammation, and reduce the incidence complications.

Objective To investigate the efficacy,safety and feasibility of laparoscopic lymph node dissection guided by indocyanine green(ICG)fluorescence imaging.Methods A total of 30 patients with muscle-invasive bladder cancer(MIBC,T2/T3NxM0)who were admitled to the Cangzhou People's Hospital during Mar.2018 and Jun.2022 were included.The lymph nodes were cleared with ICG fluorescence imaging first,and then the remaining lymph nodes were cleared according to the standard pelvic lymph node range.The lymph node positive rate of ICG fluorescence imaging guided laparoscopic lymph node precise dissection and standard pelvic lymph node dissection was analyzed by self-comparison.Results ICG fluorescence imaging guided laparoscopic lymph node precise dissection needed shorter operation time than standard pelvic lymph node dissection[(21.80±6.80)min vs.(47.70±10.73)min,P＜0.05].There was no significant difference in the lymph node positive rate between the two approaches[(11.34±9.06)％vs.(12.36±9.43)％,P＞0.05],but the former approach caused less damage on blood vessels and nerves.Conclusion Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable efficacy to standard pelvic lymph node dissection,which can reduce ineffective lymph node dissection,shorten the operation time,and reduce the risk of complications.

Objective:To observe the efficacy and safety of the M receptor antagonist Bencycloquidium bromide nasal spray in treatment of seasonal allergic rhinitis with runny nose as the main symptom. Methods:From August 2021 to September 2021, 134 patients with seasonal allergic rhinitis were enrolled in the otolaryngology Outpatient Department of Peking University Third Hospital, First Affiliated Hospital of Harbin Medical University and China-Japanese Friendship Hospital of Jilin University, including 71 males and 63 females, with a median age of 38 years. TNSS score and visual analogue scale（VAS） of total nasal symptoms were observed during 2 weeks of treatment with Bencycloquidium bromide nasal spray. Results:TNSS score decreased from （8.89±3.31） on day 0 to （3.71±2.51） on day 14（P<0.001）, VAS score of nasal symptoms decreased from （24.86±7.40） on day 0 to （6.84±5.94） on day 14（P<0.001）, VAS score of rhinorrhoea decreased from （6.88±2.06） on day 0 to （1.91±1.81） on day 14（P<0.001）. Rhinoconjunctivitis quality of life questionnaire（RQLQ） score decreased from （94.63±33.35） on day 0 to （44.95±32.28） on day 14（P<0.001）. The incidence of adverse reaction was low and no serious adverse events occurred during the whole experiment. Conclusion:Bencycloquidium bromide nasal spray has significant efficacy and good safety in the treatment of seasonal allergic rhinitis.
Male ; Female ; Humans ; Adult ; Rhinitis, Allergic, Seasonal/drug therapy* ; Nasal Sprays ; Quality of Life ; Administration, Intranasal ; Rhinorrhea ; Double-Blind Method ; Treatment Outcome ; Rhinitis, Allergic/drug therapy*

Objective To investigate the influence of limonin on the malignant biological behavior of non-small cell lung cancer (NSCLC) cells by regulating the protein tyrosine kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. Methods CCK-8 method was applied to detect the survival rate of A549 cells treated with different concentrations of limonin (0, 5, 10, 25, 50, 75, 100 μmol/L). A549 cells were separated into normal culture (NC) group, low-dose limonin group (treatment with 10 μmol/L limonin for 24 h), medium-dose limonin group (treatment with 25 μmol/L limonin for 24 h), high-dose limonin group (treatment with 50 μmol/L limonin for 24 h), coumermycin A1 group (treatment with 10 μmol/L JAK2 activator coumermycin A1+50 μmol/L limonin for 24 h), and AG490 group (treatment with 10 μmol/L JAK2 inhibitor AG490+50 μmol/L limonin for 24 h). Clone formation assay was applied to detect the clones of each group of cells. Transwell assay was applied to detect cell migration and invasion, and flow cytometry was applied to detect apoptosis. Western blot analysis was applied to detect the protein expression levels of JAK2, p-JAK2, STAT3, p-STAT3, E-cadherin, N-cadherin, and vimentin in each group. Results The viability of A549 cells decreased significantly in a limonin concentration-dependent manner (P < 0.05), with IC₅₀ of 45.16±1.66 μmol/L. Concentrations of 10, 25, and 50 μmol/L were selected for subsequent experiments. The numbers of clones, migration, and invasion of A549 cells and the protein expression levels of IL-6, p-JAK2, p-STAT3, N-cadherin, and vimentin in the low-, medium-, and high-dose limonin groups significantly decreased, compared with those in the NC group, and the apoptosis rate and E-cadherin protein expression significantly increased (P < 0.05). The JAK2 activator coumermycin A1 attenuated the ability of limonin to inhibit the proliferation, migration, invasion, and other malignant biological behavior of A549 cells and attenuated the apoptosis ability. The JAK2 inhibitor AG490 enhanced the ability of limonin to inhibit the proliferation, migration, invasion, and other malignant biological behavior of A549 cells and enhanced the apoptosis ability. Conclusion Limonin can inhibit the malignant biological behavior of NSCLC cells, such as proliferation, migration, and invasion, by inhibiting the JAK2/STAT3 pathway.

Background Stroke has become a main cause of death in China. With global warming, the studies on temperature and stroke have attracted much attention. Objective To analyze he relationships between heatwave and the years of life lost (YLL) by different subtypes of stroke by controlling temporal and spatial effects with Bayesian spatio-temporal model, and to study the modifiers of the health effect of heatwave. Methods The daily information of stroke deaths, meteorological data, and air pollutant data in 40 districts and counties of Guangdong Province were collected during the warm seasons (from May to October) in the years from 2014 to 2017. The individual YLL was first calculated by matching age and gender according to the life table, and then the daily YLL rate (person-years/100 000 people) was obtained by summarizing the daily YLL and correcting it with the population of each district or county. Bayesian spatio-temporal model was used to fit a proposed exposure-response relationship between heatwave and the YLL rates of different subtypes of stroke. Finally, stratified analyses were conducted by age (<65 years, ≥65 years), gender (male, female), and region (Pearl River Delta and non-Pearl River Delta regions) to identify the major modifiers for the association between heatwave and stroke mortality. Results During the warm seasons from 2014 to 2017, a total of 23 heatwave events occurred in the 40 districts or counties of Guangdong Province, cumulatively lasting for 145 d. A total of 30 852 stroke deaths were recorded in the same time periods. The average daily YLL rate of total stroke was (2.39±3.63) person-years/100 000 people, and those for hemorrhagic stroke and ischemic stroke were (1.54±2.99) person-years/100 000 people and (0.84±1.85) person-years/100 000 people, respectively. Heatwave was associated with increased YLL rate of stroke in residents, and it had a greater impact on ischemic stroke with a lag effect. The largest cumulative effect of heatwave was at lag 0-1 day, which was associated with an increased YLL rate of total stroke and ischemic stroke by 0.17 (95%CI: 0.03-0.29) person-years/100 000 people and 0.13 (95%CI: 0.06-0.20) person-years/100 000 people, respectively. The results of stratified analyses showed that heatwave had a larger effect on ischemic stroke in residents of aged 65 years or older, male, and non-Pearl River Delta regions, and the rates of YLL increased by 1.11 (95%CI: 0.58-1.55), 0.13 (95%CI: 0.03-0.23), and 0.20 (95%CI: 0.07-0.32) person-years/100 000 people, respectively; Heatwave only had an effect on hemorrhagic stroke in residents aged 65 years or older with an increased YLL rate of 0.79 (95%CI: 0.26-1.31) person-years/100 000 people. Conclusion Heatwave could elevate the level of years of life lost associated with stroke in Guangdong residents, with greater impacts on ischemic stroke of the aged, men, and residents in non-Pearl River Delta regions, and on hemorrhagic stroke in the elderly.

Objective To determine the genotype and clustering characteristics of multidrug-resistant (MDR) mycobacterium tuberculosis in Wuhan City. Methods A total of 149 mycobacterium tuberculosis strains from MDR tuberculosis (MDR-TB) patients were genotyped by DTM-PCR, mycobacterial interspersed repetitive unit–variable number tandem repeat typing (MIRU-VNTR) and sequencing of drug-resistant associated genes. The Hunter-Gaston discriminatory index (HGDI), clustering rate and recent minimum estimated infection rate were calculated. Results The cumulative HGDI of all MIRU loci was 0.9944. Gene locus with the highest HGDI（0.6467）was QUB11b. Combing MIRU-VNTR and DTM-PCR, 111 unique genotypes and 11 clustered genotypes（38 strains）from 149 isolates were identified. The clustering rate was 25.50%, and the recent minimum infection rate was estimated to be 18.12%. After further genotyping by sequencing of drug-resistant associated genes, the results showed that 17 (44.74%) strains in each cluster shared the same mutation sites, while the other strains had different mutation sites. Conclusion The combination of DTM-PCR, 24 locus MIRU-VNTR typing and drug resistance gene sequencing demonstrates a relatively high discriminatory power, which is suitable for the genotyping of multi drug resistant mycobacterium tuberculosis in Wuhan. The epidemic of MDR-TB in Wuhan is mainly caused by reactivation, and the recent transmission rate is not high.

Objective:To analyze the biomechanical characteristics of bilateral lumbo-iliac fixation by finite element analysis after digital optimization of a safe screw pathway.Methods:Firstly, a healthy adult male volunteer was recruited for this study who underwent CT scanning of the lumbus and pelvis, with a slice thickness of 0.625 mm.The original data were imported into Mimics 16.0 software for 3D lumbar and pelvic reconstruction.At the same time, a geometric screw pathway and a free screw pathway were generated in the pedicles of L4 and L5 and ilium.Secondly, all 3D models were imported into Ansys 12 software to assemble a finite element model.The displacements and von Misses stress distribution were measured in the conditions of forward bending, backward extending, lateral bending to the left and right, and left and right rotations in the models of 2 kinds of pathway after gravity axial load of 500 N was applied.Results:The models of 2 different pathways were similar in comprehensive displacement and stress in the conditions of forward bending, lateral bending and backward extending, and in the maximum stress of the screw in the conditions of forward bending and lateral bending.However, the comprehensive displacement and stress in the condition of rotation and the stress of the screw in the conditions of backward extending and rotating in the model of geometric screw pathway were obviously smaller than those in the model of free screw pathway.The maximum pelvic stress was on the screw surface between 190 and 260 MPa, concentrated on the bending area of the 2 screws connecting the sacrum and vertebral body.The lumbar-iliac fixation model showed high com-pressive stiffness.The maximum von Misses stress appeared in the L4-L5 pedicle screw on the longitudinal rod.Under rotational loading, the upper longitudinal rod connecting the L4-L5 pedicle screw and the iliac bone screw bore the maximum stress.Conclusions:Our finite element analysis shows that double verte-bral bodies and long screw fixation are effective ways of iliolumbar fixation.The geometric screw path optimized by digital analysis exhibits better fatigue resistance, rotation resistance and overall stability.Internal lum-bo-iliac fixation can effectively share the stress of vertebral bodies.