Objective To investigate associations between three-dimensional(3D)morphology of cervical vertebrae and skeletal mat-uration by cone-beam computed tomography(CBCT)and establish corresponding regression models for quantitatively evaluating cervical vertebral maturation(CVM).Methods The analyzed sample consisted of 358 CBCT images(175 male,183 female),of which 277 images were randomly selected as the model development group and 81 as the performance test group.Twenty-one 3D morphological pa-rameters were defined and measured,incorporating all parts of the cervical vertebrae,including the cervical vertebral bodies,transverse processes,spinous processes,pedicles,lamina,and articular processes.The cervical vertebral maturation index(CVMI)was determined by experienced orthodontists as reference standard.Spearman's rank correlation coefficient and multivariable stepwise regression analysis were used to identify the associations and build regression models.The performance test group was employed to ex-amine each model's reliability.Paired-samples Wilcoxon signed-rank test compared the CVMI of the model prediction with the reference standard.Results Three-dimensional morphological changes in various parts of the cervical vertebrae correlated with CVMI(P＜0.05).Six 3D morphometric parameters were each recognized for male and female models,three of which were identical.The adjusted R2 was 0.899 for males and 0.902 for females,with corresponding accuracies of 85.0%and 85.4%,respectively.These models showed no difference as compared with the reference standard(P＞0.05).Con-clusion New associations were found between 3D morphology of cer-vical vertebrae and skeletal maturation.The 3D-driven morphometric CVM assessment method and corresponding regression models exhibited good credibility and high consistency with experts.

Objective:To summarize the best evidence for the use of ankle pump exercises in preventing perioperative lower limb deep vein thrombosis (DVT) in patients undergoing joint replacement surgery and to evaluate its clinical application.Methods:This study utilized an evidence-based continuous quality improvement model. A systematic search was conducted for relevant clinical practice guidelines, expert consensus, systematic reviews, and randomized controlled trials (RCTs) from both domestic and international sources. The best evidence was evaluated and summarized, and audit indicators were developed for baseline assessments. Facilitating and hindering factors were analyzed based on the baseline results. From December 2022 to April 2023, the evidence was applied in the Department of Orthopedics at Henan Provincial People's Hospital. The pre-evidence group for baseline assessments included 36 joint replacement patients and 18 nurses from the orthopedic unit between December 2022 and January 2023, while the post-evidence group included 36 joint replacement patients and the same 18 nurses between March and April 2023. The knowledge level of nurses, the effectiveness of ankle pump exercises, the execution rate, and patient compliance were compared before and after evidence-based practice.Results:A total of 12 articles were included in the study, comprising one clinical practice guideline, five expert consensus papers, one systematic review, and five RCTs. Ten best practices were summarized in terms of applicable populations, exercise assessment, exercise positions, timing, methods, frequency, and patient education. After implementing evidence-based practice, the knowledge scores of nurses on ankle pump exercises significantly improved from (70.56±9.98) to (82.78±8.26) ( P<0.01). The compliance rates of audit items 2, 3, 4, 5, and 6 among nurses increased from 0, 22.2%, 0, 27.8%, and 11.1% respectively, to 94.4%, 94.4%, 83.3%, 100.0%, and 100.0% respectively ( P<0.01). On the patient side, the compliance rates for audit items 7 and 8 increased from 5.6% and 0 to 86.1% and 94.4%, respectively ( P<0.01) . Conclusions:Implementing evidence-based ankle pump exercises to prevent DVT in joint replacement patients can significantly improve nurses' knowledge of evidence-based practice, standardize the practice of ankle pump exercises, and explore balanced educational strategies that enhance patient compliance, ensuring clinical practices are evidence-based.

Objective:To observe the application effect of health education based on health action process approach (HAPA) theory in perioperative patients undergoing knee arthroplasty.Methods:Using the convenient sampling method, a total of 168 patients who underwent knee arthroplasty in Henan Provincial People's Hospital from March 2020 to May 2021 were selected, and they were randomly divided into the observation group (85 cases) and the control group (83 cases). The control group received routine care, while the observation group received health education based on HAPA theory on the basis of the control group. The scores of Self-efficacy for Rehabilitation Outcome Scale (SER) and Quality of Life Questionnaire Core 30 (QLQ-C30), postoperative recovery indicators and complications, patient compliance and patient satisfaction before and after intervention were compared between the two groups.Results:After intervention, scores of SER, QLQ-C30, compliance and satisfaction in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The first time of getting out of bed, the time of knee flexion greater than or equal to 90°and the length of hospital stay in the observation group was shorter than those in the control group, and the total incidence of complications was lower than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Health education based on HAPA theory can effectively improve the self-efficacy, compliance and quality of life of patients undergoing knee arthroplasty, reduce the risk of complications, promote postoperative recovery and obtain satisfaction of patients.

Objective:To explore the effect of feedback health education combined with positive psychological suggestion on the rehabilitation of patients undergoing artificial total knee arthroplasty.Methods:From August 2020 to July 2021, the convenient sampling method was used to select 126 patients with artificial total knee arthroplasty admitted to the Orthopedic Department of Henan Provincial People's Hospital. They were randomly divided into the control group and the observation group in a 1∶1 ratio using a random number table method. The control group received routine health education combined with positive psychological suggestion, while the observation group received feedback based health education combined with positive psychological suggestion intervention. The level of knowledge, attitude and practice, scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analogue Scale (VAS), American Knee Society (AKS) score, knee swelling rate and nursing satisfaction were compared between two groups of patients.Results:The knowledge, attitude and practice scores of the two groups at discharge were higher than those at admission ( P<0.05), and the knowledge, attitude and practice scores of the observation group were higher than those of the control group at discharge ( P<0.05). The SAS and SDS scores of the observation group were lower than those of the control group before and on the third day after surgery ( P<0.05). The VAS of the observation group on the first day and 2 weeks after surgery were lower than those of the control group ( P<0.05), while AKS was higher than that of the control group ( P<0.05). The postoperative swelling rates in the observation group were lower than those in the control group at 1 week and 3 months after surgery ( P<0.05). The nursing satisfaction scores of the observation group in terms of health education, service attitude, department environment, psychological intervention, and nursing outcomes were higher than those of the control group ( P<0.05) . Conclusions:Feedback health education combined with positive psychological cues can improve the knowledge, attitude and practice levels of patients undergoing artificial total knee arthroplasty, reduce anxiety and depression, and improve rehabilitation effectiveness and nursing satisfaction.

Objective:To carry out the overview of systematic reviews on effectiveness and safety assessment of pneumatic compression devices (PCD) on preventing venous thromboembolism (VTE) .Methods:Systematic reviews or Meta-analysis comparing PCD with other physical prophylaxis and drug prophylaxis were retrieved by computer in the Cochrane Library, PubMed, Embase, China National Knowledge Internet (CNKI) , China Biological Medicine, WanFang data from building the database to 31st March 2019. Two researchers independently implemented the literature screening, data extraction and quality evaluation. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used to quality assessment of methodology for included literatures. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to quality evaluation for outcome indexes.Results:Totals of 15 systematic reviews or Meta-analysis were included with 8 in Chinese and 7 in English. There were 11 literatures published after 2012. Quality assessment of methodology showed that 3 literatures met 11 items of AMSTAR, and other researches had the defect existed in different aspects. Evidences with the medium quality displayed the effectiveness of intermittent pneumatic compression devices in VTE prevention which could reduce the incidence of adverse events caused by separate drug prophylaxis, such as bleeding, through combining with drug prophylaxis. Application of intermittent pneumatic compression devices for VTE prevention should be based on clinical guidelines. At present, there was limited evidence guiding selection of specific device and device type.Conclusions:Intermittent pneumatic compression devices are safe and effective in VTE prevention which still needs to be demonstrated by researches with the large sample and high of quality.

Objective: To establish a mouse model of osteoarthritis (OA) and study the bone microarchitecture and bone metabolism of tibial subchondral bone in early stage of OA. Methods: The mouse model of post-traumatic osteoarthritis (PTOA) with anterior cruciate ligament (ACLT) was established by using c57 mice. The Sham operation group served as the control group. All mice were fed with conventional diet. All mice were sacrificed after 4 weeks. The degeneration of knee joint was observed by HE staining and Safranin O-Fast Green staining. The number of osteoclasts was counted by TRAP staining. Micro CT was used to analyze the quantitative parameters of the microstructure of tibia subchondral bone in mice. Serum levels of bone resorption biomarker CTX I and cartilage degeneration marker CTX II were determined. Results: After ACLT 4 weeks, the average score of OARSI in ACLT group was 3.2, which was higher than that in Sham group, and the joint degeneration occurred in mice, presenting the pathological characteristics of early OA. Compared with the sham operation phase, the total subchondral bone volume (TV) of ACLT group was 4.72 mm³, increased by 13.6%; the bone trabecular resolution (Tb.Sp) was 0.130 and 0.154 mm, respectively, and the ACLT group also increased by 18.8%; the bone volume/tissue volume (BV/TV) was 0.470 and 0.294, respectively, and the ACLT group decreased by 48.9%; the bone trabecular thickness (Tb.Th) was 0.162 and 0.083 mm groups, ACLT decreased by 37.5%. Trap staining showed that the number of osteoclasts per unit volume in ACLT group was 72, which was significantly higher than that in sham operation group. The CTX I of mice in the sham operated ACLT group and sham operated group were 20.9 ng/ml and 18.29 ng/ml, with an increase of 48.9% in the ACLT group; the CTX II of mice in the ACLT group and sham operated group were 35.5 ng/ml and 28.6 ng/ml, with an increase of 24.1% in the ACLT group. Conclusion ACLT Mouse model can successfully construct early OA, which confirms the early loss of osteochondral bone and the pathological changes of osteoclast activation in OA, and provides a new specific target for the treatment of OA.

Objective To evaluate an effective and feasible quantitative evaluation table of traditional Chinese medicine (TCM) syndrome differentiation, and to observe the effect of combination of TCM syndrome differentiation and standard bundle therapy in patients with septic shock. Methods A prospective randomized controlled trial was conducted. The septic shock patients with acute deficiency syndrome admitted to department of critical care medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1st, 2016 to December 31st, 2017 were enrolled. The patients were randomly divided into control group and Shenfu group. The patients in both groups received early application of standardized bundle therapy; those in Shenfu group received 60 mL Shenfu injection infusion in addition for 7 days. The TCM syndrome score was evaluated by classification and scoring method of TCM symptoms. The circulation and tissue perfusion, severity of disease, organ function, inflammation response, adjuvant treatment and 28-day mortality were compared between the two groups. Results A total of 50 patients with septic shock were enrolled in the analysis, 25 in control group and 25 in Shenfu group. The markedly effective rate of TCM symptoms score in Shenfu group was significantly higher than that in control group [60.0% (15/25) vs. 16.0% (4/25), P < 0.01]. There was no significant difference in all parameters before treatment between the two groups. After treatment, the observation indexes of both groups were improved. Compared with control group, the mean arterial pressure (MAP) in Shenfu group increased more significantly [mmHg (1 mmHg = 0.133 kPa): 13.0 (2.5, 28.5) vs. 6.0 (0, 13.5)], the lactate (Lac) and procalcitonin (PCT) decreased more significantly [Lac (mmol/L): 0.8 (0.1, 3.7) vs. 0.5 (-0.6, 1.7), PCT (μg/L): 2.0 (0.7, 32.3) vs. 0 (-1.8, 3.8)], activated partial thromboplastin time (APTT) was shortened more significantly [s: 8.5 (0, 12.9) vs. 0 (-7.2, 10.0)], and interleukins (IL-2 receptor and IL-6) levels decreased more significantly [IL-2 receptor (ng/L):1 031.0 (533.0, 1 840.0) vs. 525.5 (186.0, 1 166.8), IL-6 (ng/L): 153.1 (21.4, 406.8) vs. 35.1 (16.3, 110.1)] with significant differences (all P < 0.05). There was no significant difference in the use time of vasoactive drugs, duration of mechanical ventilation, severity of the disease or 28-day mortality between the two groups. However, the use time of vasoactive drugs in Shenfu group was shorter than that in control group (days: 5.48±4.81 vs. 8.28±7.83), and the 28-day mortality was decreased [8.0% (2/25) vs. 20.0% (5/25)]. Conclusions TCM syndrome score is helpful to evaluate the effect of TCM syndrome differentiation and treatment, and it is effective and feasible in clinical application. Septic shock patients treated with TCM syndrome differentiation and treatment combined with standard bundle therapy were significantly improved in circulation, tissue perfusion, coagulation function and inflammation reaction.

Objective To investigate the effect of the focus intervention on the rehabilitation of patients with total hip replacement. Methods From March 2014 to March 2016, selected 166 cases of elderly patients with total hip replacement, the patients were divided into observation group (89 cases) and control group (77 cases) according to admission orders, 77 cases from March 12014 to February 282015 are classified as the control group, whereas 89 cases from March 12015 to February 292016 are classified as the experimental group. The observation group was treated with focus intervention, and the control group received routine nursing care, observed two groups postoperative rehabilitation effect, the incidence of postoperative lower extremity venous thrombosis and infection, and patient satisfaction with care, etc. Results The postoperative recovery of hip function in the observation group was better than that in the control group (Z=-2.787, P<0.05), the excellent and good rate was 88.76％(79/89), and the excellent and good rate in control group was 80.52％(62/77). The incidence of postoperative lower extremity venous thrombosis and infection in the observation group were 3.37％(3/89) and 2.25％(2/89), significantly lower than the control group12.99％(10/77)and 10.39％(8/77), the difference was statistically significant (χ2=5.289 and 4.835, P<0.05). The VAS scores of the observation group and the control group were (2.43 ± 0.84) points and (2.59 ± 0.91) points, the difference was not statistically significant(t=-1.177, P>0.05). The nursing satisfaction in observation group was 92.13％(82/89), significantly higher than that in the control group72.73％(56/77), the difference was statistically significant (χ2=11.089, P < 0.05). Conclusion The focus intervention on the functional recovery of patients with total hip replacement may have some help, reduce complications and improve patient satisfaction.

Objective To investigate the feasibility and results of unilateral Crowel Ⅳdevelopmental dyspepsia of the hip(DDH)length of bone shortened in operation by using adjustable orthopedics and measuring the double leg length X-ray PA at erect position before operation. Methods Totally 18 unilateral Crowel Ⅳ DDH patients underwent total hip replacement(THR)between January 2013 and June 2014, there were 6 male and 12 female patients with a mean age of (47.5 ± 3.1) years old. Before operation, the double leg length X-ray PA was measured, lumbosacral portion pain by Numeric Rating Scale(NRS)and activities of daily living(ADL) were assessed. The responsible nurses provide comprehensive health education and instruction on functional exercises, instruct patients to wear adjustable orthopedics to walk until they felt two legs were equilong and a balanced walking for one month. With the orthopedics'adjustable height and the double leg length X-ray PA at erect position, calculating the length of bone shortened in operation. Postoperative follow-up was carried out for (2.7±0.2) years, the lumbosacral portion pain was assessed by NRS and ADL at last follow-up. Results On the last follow-up, there was a normal gait, the lumbosacral portion pain assessed by NRS, ADL score, score of physical self-maintenance dimension, score of instrumental activities of daily living dimension were 3.1±0.6, 76.2± 4.7, 18.2 ± 8.2, 44.8 ± 6.1, and were 8.7 ± 0.3, 43.3 ± 9.5, 31.4 ± 3.6, 25.1 ± 9.8 before operation, there were statistic differences between them (t=6.25-35.41, P<0.01). Conclusions Using adjustable orthopedics before operation can calculate exactly the length of bone shortened in operation, simplify the operation process. After operation, there is obvious gait improvement and satisfying clinical effect.

Objective To observe the effect of Sanqi Oral Liquid on the podocytes and the expression of slit diaphragm-associated molecules (including Nephrin, Podocin and CD2AP proteins) of diabetes mellitus (DM) rats after unilateral nephrectomy, so as to explore its mechanism for protecting renal function. Methods SD male rats were randomized into sham operation group, model group and Chinese medicine group. The experimental diabetes mellitus ( DM) model was given unilateral nephrectomy and intraperitoneal injection of 35 mg/kg of streptozocin (STZ). And then the model rats were given intragastric administration of Sanqi Oral Liquid (2.5 g· kg-1·d-1) and the same volume distilled water respectively for 8 weeks. After treatment, the density of podocytes and the podocytic foot process width of different groups were measured. Immunohistochemistry was used to observe the changes of the expression of Nephrin, Podocin and CD2AP in renal tissues of different groups. Results After treatment with Sanqi Oral Liquid, the density of podocytes was increased, the foot process lesion was relieved, and the expression levels of Nephrin, Podocin and CD2AP proteins were increased (P<0.05 or P<0.01 as compared with those in the model group). Conclusion The protective mechanism of Sanqi Oral Liquid for renal function of unilateral nephrectomy DM rats is possibly related with the alleviation of podocyte injury and with the regulation of the expression of Nephrin, Podocin and CD2AP proteins in podocytes.