BACKGROUND:Up to now,there is no literature on the relationship between blood laboratory tests and the course of nontraumatic osteonecrosis of femoral head in different stages.It is necessary to further explore and analyze so as to better clarify the influencing factors of nontraumatic osteonecrosis of femoral head. OBJECTIVE:To analyze the relationship between blood laboratory indicators and the course of nontraumatic osteonecrosis of the femoral head by the Association Research Circulation Osseous(ARCO),thus exploring the influencing factors of blood laboratory indicators on the course of nontraumatic osteonecrosis of the femoral head. METHODS:This study used a retrospective study design.A total of 2 103 patients with osteonecrosis of the femoral head were retrieved from Wangjing Hospital of China Academy of Chinese Medical Sciences database,and 1 075 patients with nontraumatic osteonecrosis of the femoral head were ultimately included based on inclusion and exclusion criteria.Patient age,gender,body mass index,and blood laboratory test results were collected.Blood laboratory tests included low-density lipoprotein,total cholesterol,triglycerides,high-density lipoprotein,apolipoprotein β,apolipoprotein α1,uric acid,total protein quantitative,alkaline phosphatase,activated partial thromboplastin time,prothrombin time,prothrombin time International Normalized Ratio,prothrombin time activity,fibrinogen quantitative,coagulation time of thrombin,D-dimer,total iron binding capacity,and platelet count.The indicators of patients with different age groups and different ARCO stages were compared,and multiple Logistic regression analysis was applied to explore the influencing factors of ARCO stages in osteonecrosis of the femoral head. RESULTS AND CONCLUSION:(1)There were statistical differences in total cholesterol,uric acid,prothrombin time,prothrombin time International Normalized Ratio,and D-dimer among ARCO stages in the young group(P<0.05).Among young patients in ARCO stage II,total cholesterol levels were higher than those in ARCO stage III(P<0.05).Uric acid levels in ARCO stage IV were higher than those in ARCO stage II and III(P<0.05).Prothrombin time and prothrombin time International Normalized Ratio were shorter in ARCO stage IV and II than in ARCO stage III(P<0.05).D-dimer levels were higher in ARCO stage III and IV than in ARCO stage II(P<0.05).(2)There were statistically significant differences in high-density lipoprotein,coagulation time of thrombin,and D-dimer among ARCO stages in the middle-aged group(P<0.05).Among middle-aged patients in ARCO stage IV,high-density lipoprotein levels were higher than those in ARCO stages II and III(P<0.05).Coagulation time of thrombin was shorter in ARCO stage IV than in ARCO stage III(P<0.05).D-dimer levels were higher in ARCO stages IV than in ARCO stages II and III(P<0.05).(3)The uric acid,activated partial thromboplastin time,D-dimer,and platelet count in the elderly group showed statistically significant differences(P<0.05).The uric acid level in ARCO stage IV was higher than that in ARCO stage II and III patients in the elderly group(P<0.05),while the activated prothrombin time in ARCO stage II patients was shorter than that in ARCO stage III patients in the elderly group(P<0.05).The D-dimer level in ARCO stage III and IV patients was higher than that in ARCO stage II patients in the elderly group(P<0.05).The platelet count in ARCO stage IV was lower than that in ARCO stage III patients in the elderly group(P<0.05).(4)Multiple logistic regression analysis showed that total cholesterol and platelet count may be protective factors for course of nontraumatic osteonecrosis of the femoral head,while D-dimer,uric acid,overweight,and young and middle age may be risk factors for course of nontraumatic osteonecrosis of the femoral head.(5)It is indicated that total cholesterol,high-density lipoprotein,uric acid,prothrombin time,prothrombin time International Normalized Ratio,and D-dimer are statistically significant among patients with different ARCO stages.Total cholesterol and platelet count may be protective factors for the course of nontraumatic osteonecrosis of the femoral head,while D-dimer,uric acid,overweight,and middle-aged and young age groups may be hazard factors for the course of nontraumatic osteonecrosis of the femoral head.

Objective To discuss the entries of prognostic factors affecting osteonecrosis of the femoral head(ONFH);To determine optimized and uniform prognostic influences.Methods Through literature pre-search and clinical research,the questionnaire was designed.Experts were selected based on the Delphi method and the questionnaire was distributed to the experts online,and after the questionnaire was recovered,Excel 2016 and SPSS 26.0 software were applied to process the data.The positive coefficients of experts,the degree of authority of experts,the degree of coordination of experts'opinions,the degree of concentration of experts'opinions,and the weight coefficients of the entries were calculated for the evaluation of the importance.Results Totally 116 articles were included.A list of prognostic factors indicators based on original literature was extracted.The first and second rounds of consultation had 30 and 40 experts respectively,and the collected questionnaires were all valid.Finally,10 major prognostic factors affecting ONFH were identified,including whether strictly on crutches,whether in pain(duration of pain),hip mobility,time to confirmation of osteonecrosis,ARCO staging,JIC staging,whether the anterolateral column is preserved,necrotic area,CT supracondylar subchondral fracture zone,and oral administration of traditional Chinese medicine.Conclusion This article summarizes the relevant factors that affect the progression of ONFH,which can further enhance clinical physicians'understanding of the prognosis of ONFH,and can delay the progression of ONFH by effectively intervening in important factors.

125I seeds implantation for the treatment of various malignant tumors has been widely recognized in clinical practice in recent years. It has a wide application prospect and is an effective treatment method. With the development of ultrasound, CT, MR, endoscopy and three-dimensional (3D)-printing technology, the clinical application of 125I seeds implantation technology is progressing rapidly. This article summarizes its implementation methods, clinical applications and development trends.

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

Objective:To summarize the experience of blood glucose management and nursing for a newborn with repeated hypoglycemia in Beckwith-Wiedemann syndrome.Method:A multidisciplinary team was formed, and formulated an individualized care plan for a large infant with Beckwith-Wiedemann syndrome. A dynamic blood glucose monitoring system was used to closely monitor blood glucose fluctuations for this children, dynamically adjusted the amount of infusion and milk according to the blood sugar situation, detected and dealed with hypoglycemia in time, strengthened the skin care of child and implemented psychological care for the family.Results:After refined treatment and care, the child′s vital signs were stable, and his blood sugar could maintain within a normal range before being discharged from the hospital.Conclusions:The use of dynamic blood glucose monitoring system under the guidance of a multidisciplinary team can effectively monitor and control the blood glucose fluctuations of children with BWS syndrome, which can provide a basis for further treatment of children.

Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided microwave ablation ( EUS-MWA ) for porcine liver and pancreas by assessing physiological state and pathological changes. Methods EUS-MWA was performed on liver and pancreas of 8 healthy pigs after general anesthesia. The needle size was 1. 9 mm in diameter, and the power of ablation was 65 W, 10 min on liver and 60 W, 5 min on pancreas. The levels of blood amylase and hepatic transaminase were examined before and after the operation. All pigs underwent CT scan on the right postoperative day to assess the extent of ablation and complications. Two pigs were killed 6 hours after operation and 2 others were killed 24 hours after operation to assess structural damage around the puncture path. The remaining 4 pigs were raised to 2 weeks after operation to observe diet, activities and mental state. The ablated areas of liver and pancreas underwent pathological analysis after dissection, and non-ablation regions were treated as the control. Results All 8 pigs underwent EUS-MWA and their vital signs were stable during the operation. Except for the difficulty in locating the pancreas in one case, other surgical procedures were smooth and 18 ablations were performed totally ( 10 in liver and 8 in pancreas) . CT scans showed quasi-circular low density lesions in the liver and pancreas, and the maximum diameter of the ablation area in liver and pancreas was 2. 8 ± 0. 3 cm, 1. 8±0. 2 cm respectively. There was no free intraperitoneal gas, ascites or pleural effusion. The level of blood amylase increased at 6 hours after operation and the peak value occurred within 12-24 hours. The level of hepatic transaminase had a mild elevation. The rearing group showed transient food refusal and activity reduction after the operation, but all returned to normal within 1-2 days. No fever, vomiting or other abnormalities occurred. Puncture path burn, adjacent organ damage and bleeding was not observed except for one case of gastric wall burns during pancreas ablation. Pathology showed massive coagulative necrosis and peripheral bleeding area in the liver ablation center, and diffuse focal necrosis in the tissue of the pancreatic ablation area. Conclusion EUS-MWA is safe and feasible for porcine liver and pancreas, which can be used for the treatment of human liver and pancreatic diseases in the future.

Objective To comparatively analyze the SD rat chloasma model established by using the two methods of progesterone injection and ultraviolet radiation.Methods The rat chloasma model was established by adopting the high and low doses of progesterone injection and ultraviolet irradiation.The plaque area was observed and the skin section was observed by light microscope.The SOD and MDA levels closely related with chloasma melanin deposition were detected.Results The significant pigment deposition on the back skin in the high dose progesterone group was seen by naked eye and the scattered pigment deposition was seen in the low dose progesterone group;significant pigment deposition could be found in the ultraviolet group.Compared with the control group,the MDA level of various tissues in the high dose progesterone group was increased,while the SOD level was decreased,serum and skin SOD level in the low dose progesterone group was decreased,the difference was statistically significant(P＜0.05).Serum and skin SOD level in the high dose ultraviolet group was decreased,while the MDA level was increased,the skin SOD level in the low dose ultraviolet group was decreased(P＜0.05),but the difference between the two groups was not statistically significant (P＞0.05).The melanin grains were heaped up as the small black body under light microscope,which in the progesterone group showed the clutter distribution,the difference between the high dose group and low dose group was significant;which in the ultraviolet group showed the linear dense arrangement and the intergroup had no significant difference.Conclusion Progesterone injection and ultraviolet irradiation all can successfully establish the SD rat chloasma model,and the constructing model effect and stability of ultraviolet irradiation are better.

Objective To compare the default mode network (DMN) between patients with gastroesophageal reflux disease (GERD) and healthy controls (HCs).Methods Included for this study were 30 GERD patients who were treated at Department of Digestive Diseases,Zhujiang Hospital from September 2016 to December 2017 and contemporary 49 HCs who received health examination at the out-patient department.Resting-state functional magnetic resonance imaging (fMRI) was conducted for the 2 groups.Fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) were used to study significant alterations in their DMN.Results Compared with the HCs,the GERD patients demonstrated the following alterations:the ReHo values were significantly decreased in bilateral superior temporal gyri,middle temporal gyri and dorsal anterior cingulate cortexes (dACC) but significantly increased in bilateral medial prefrontal lobes,dorsal anterior cingutates,posterior cingulates,precunei,and angular gyri;the fALFF value was increased in bilateral dACC and precunei but decreased in the paracentral lobules (P＜0.05).Conjunction analyses using both ReHo and fALFF values of their DMN showed the overlapping activated brain regions lied in the paracentral lobules,dACC and precunei.The fALFF values in the paracentral lobules and the dACC of the GERD patients were negatively correlated with their disease course (r=-0.380,P=0.035;r=-0.375,P=0.041) while the ReHo values in the superior temporal gyri of the GERD patients were also negatively correlated with their disease course (r=-0.446,P=0.016).Conclusion In GERD patients,their DMN might undergo dysfunctional changes because of the abnormal activity of DMN which may be correlated with their disorder of visceral sensation.

Objective To evaluate the guidance value of capsule endoscopy and clinical scoring system in risk stratification for acute upper gastrointestinal bleeding (AUGIB) .Methods 24 patients presenting to the emergency room with AUGIB ,were randomly divided into two groups (12 cases in each group) .Pre‐Endoscopic Blatchford and Rockall scores were calculated for all pa‐tients .All patients underwent endoscopy(EGD) within 24 hours .The timing of EGD was based on clinical scores in control group , and on VCE in observation group .Positive VCE was defined as red blood ,clot or coffee grounds .Mean Rockall and Blatchford scores for all 24 patients were compared to differentiate high‐and low‐risk patients .Rockall and Blatchford scores were also com‐pared with VCE findings .Results A total of 13 out of 24 patients had high‐risk stigmata on EGD ,with the mean Rockall and Blatchford scores of 3 and 13 respectively .Meanwhile ,the mean Rockall and Blatchford scores of the other 11 patients were 2 and 11 .There was no statistically significant difference between the Blatchford scores of the two groups(95% CI:5 .2‐1 .4 ;P=0 .23) . Also there was no statistically significant difference between the Rockall scores of the two groups(95% CI:2 .2‐0 .3;P=0 .12) .In the subgroup of 12 patients who underwent VCE ,9/12 had positive findings confirmed at EGD afterward ,compared with the other 3 patients with negative VCE and endoscopy .Conclusion Both the Rockall and the Blatchford scores are not accurate to predict the degree of risk in patients with AUGIB identified at EGD .However ,VCE is sensitive and specific enough to a better risk stratifica‐tion tool .

Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava(PIVCLS).Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong University.All patients underwent surgical resection,combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft.Results Surgical resection was performed successfully in all patients.The mean operation time was 166.6 min,with mean blood loss 1 560 mL.Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation.The mean size was 12 cm × 10 cm× 8 cm.The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination.All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood (BUN) and (CREA).All patients were administrated with oral warfarin therapy after discharge.No clinical relapse and pulmonary embolism was observed during the follow-up (range 3 months to 12 months).The ultrasound revealed the patency of artificial vascular grafts in all patients.Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS.Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics.The incidence of postoperative pulmonary embolism also decreases obviously.