Background and objective Cough is one of the main complications after pulmonary surgery,which seriously affects the postoperative quality of life.Preserving the pulmonary branch of vagus nerve may reduce the incidence of postoperative cough.Therefore,the aim of this study was to investigate whether preserving the pulmonary branch of the vagus nerve could reduce the incidence of postoperative chronic cough in patients with stage I peripheral lung adenocarcinoma.Methods A total of 125 patients who underwent single-port thoracoscopic radical resection for lung cancer in the Depart-ment of Thoracic Surgery,The First Affiliated Hospital of University of Science and Technology of China from June 2022 to June 2023 were retrospectively selected,and divided into two groups according to whether the vagopulmonary branch was preserved during the operation,namely,the vagopulmonary branch group(n=61)and the traditional group(n=64).The general clinical data,perioperative conditions,lymph node dissection,Mandarin Chinese version of The Leicester Cough Questionnaire(LCQ-MC)scores before and 8 weeks after operation were recorded in the two groups.Both the two groups were divided into tamponade group and non-tamponade group according to whether autologous fat or gelatin sponge was tamponade after lymph node dissection.LCQ-MC scores and postoperative chronic cough of both groups were calculated.Results The LCQ-MC score of the traditional group was significantly lower than that of the vagopulmonary branch group in physiological,psychological,social and total scores at 8 weeks after surgery,and the difference was statistically significant(P<0.05).There were more cough patients in the traditional group than the vagopulmonary branch group at 8 weeks after surgery,with significant difference(P=0.006).Subgroup analysis was conducted separately for the vagopulmonary branch group and the traditional group.Among the patients in the vagopulmonary branch group and the traditional group,the LCQ-MC scores of the non-tamponade group 8 weeks after surgery were lower than those of the tamponade group(P<0.05).There were more patients with cough in the group 8 weeks after surgery than in the tamponade group(P=0.001,P=0.024).Conclusion For patients with stage I peripheral lung adenocarcinoma,the preservation of the pulmonary branch of vagus nerve is safe and effective,which can reduce the incidence of postoperative chronic cough and improve the postoperative quality of life of the patients.

Traditional thoracic surgery teaching has many problems, such as limited classroom teaching time allocation, many diseases and difficult to fully cover classroom teaching, uneven practical teaching level, and difficulty in updating "big textbooks". The Department of Thoracic Surgery of The Second Affiliated Hospital of Air Force Medical University has gradually applied microlecture to all levels of thoracic surgery teaching, such as undergraduate auxiliary classroom teaching and clinical skills training, grassroots and refresher doctor training, postgraduate education, etc., and has achieved good results of teaching effect.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective:To investigate the physicochemical and biological properties of different magnesium modified calcium phosphate bone cements.Methods:The different magnesium modified calcium phosphate bone cements were divided into magnesium citrate, magnesium lactate, magnesium malate, magnesium phosphate and magnesium glycinate groups, each of which was added with different magnesium agents in the proportion of 0%, 1%, 3% and 5% of the total weight of calcium phosphate bone cements. The initial and final setting time, injectability, anti-collapse performance and compressive strength of different magnesium modified calcium phosphate bone cements were tested. Furthermore, the screened bone cement extracts were used to culture with third generation osteoblasts. Bioactivity assays were performed using the Cell Proliferation and Toxicity Assay Kit (CCK-8). Alkaline phosphatase (ALP) staining and Alizarin Red S (ARS) staining were performed on osteoblasts to observe the osteogenic activity of magnesium malate modified calcium phosphate bone cements.Results:The addition of different proportions of different magnesium agents led to the shortening of the initial and final setting time of modified calcium phosphate bone cements. Moreover, the final setting time of 5% magnesium malate modified calcium phosphate bone cements was the shortest (<40 minutes), which was significantly shorter compared with other magnesium agents in the same proportion (all P<0.05). With the addition of different magnesium agents in different proportions, the injectability of bone cements was gradually increased, and the injectability of 5% magnesium malate calcium phosphate bone cements reached the highest for (87.3±1.9)%, which was significantly increased compared with other magnesium agents in the same proportion (all P<0.05). The anti-collapse performance of bone cements was decreased with the addition of different magnesium agents in different proportions. Magnesium citrate, magnesium phosphate and magnesium glycinate modified calcium phosphate bone cements could not resist the flushing of deionized water. In particular, magnesium malate modified calcium phosphate bone cements had the best anti-collapse performance, with the maximum weight loss rate for only (9.8±2.3)% after 30 minutes of deionized water flushing, which was better than the rest of the groups (all P<0.05). The compressive strength of magnesium lactate and magnesium phosphate modified calcium phosphate bone cements showed a decrease compared with original calcium phosphate bone cements, while the compressive strength of magnesium citrate and magnesium malate modified calcium phosphate bone cements was significantly increased compared with original calcium phosphate bone cements, of which 3% magnesium malate modified calcium phosphate bone cements had the greatest compressive strength of (6.2±0.2)MPa, significantly higher than the rest of the groups (all P<0.05). The sieve test yielded magnesium malate modified calcium phosphate bone cement, which had a weight loss of (27.0±0.9)% at 35 days in vitro. The release of magnesium ions was increased with increasing magnesium malate dose in the in vitro environment of magnesium malate modified calcium phosphate bone cements in different ratios. A stable magnesium ion release was achieved within 35 days.Also, the pro-proliferative and osteogenic effects of modified calcium phosphate bone cements on osteoblasts were more obvious with increase of magnesium malate dose. For 5% magnesium malate modified calcium phosphate bone cements, the cell number, ALP staining area ratio and calcium nodule area ratio were significantly increased compared with the groups in the proportion of 0% and 1% magnesium malate (all P<0.05). Conclusions:Among magnesium citrate, magnesium lactate, magnesium malate, magnesium phosphate and magnesium glycinate modified calcium phosphate bone cements, magnesium malate modified calcium phosphate bone cements have relatively suitable setting time, excellent anti-collapse performance and mechanical strength. Meanwhile, 5% magnesium malate modified calcium phosphate bone cements have better biological activity among different ratios of magnesium malate modified calcium phosphate bone cements, suggesting a potential value for clinical application.

Objective:To investigate the expression of estrogen receptor alpha (ERα) protein and BRAF V600E protein in thyroid papillary carcinoma (PTC) and their relationship with clinical factors of PTC. Methods:The expression of ERα and BRAF V600E protein in 1 105 PTC patients was detected by immunohistochemistry. The relationship among ERα, BRAF V600E protein and clinical factors were analyzed. Results:Positive ERα protein was correlated with maleness (χ 2= 6.087, P=0.001), age< 45 years old (χ 2=5.197, P=0.023) and multifocal tumors (χ 2=4.446, P=0.035). Positive BRAF V600E protein was correlated with positive ERα protein (χ 2=6.209, P=0.013), Hashimoto thyroiditis (χ 2=29.388, P<0.001), no lateral lymph node metastasis (χ 2=6.849, P=0.009) and multifocal tumors (χ 2=9.596, P=0.035). Conclusions:ERα expression is more common in male patients, patients younger than 45 years of age, those with multifocal tumors and positive BRAF V600E protein. BRAF V600E protein may inhibit Hashimoto's thyroiditis, tumor growth and the occurrence of lateral lymph node metastasis, and promote the occurrence of multiple focal tumors.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Vitreous hemorrhage in children is caused by trauma or non-traumatic factors.Long-term vitreous hemorrhage not only affects children's vision,but also can lead secondary glaucoma,traumatic retinal detachment and other serious complications.Ocular trauma,some ocular and systemic diseases are the common etiology leading to vitreous hemorrhage in children.A small amount of vitreous hemorrhage can be treated by observation and conservative treatment.However,if the vitreous hemorrhage has no obvious absorption or serious complications appeared,it needs to be treated by surgery.The choice of treatment time and methods need to be further studied.

Objective To determine the effects of gender on distal femoral aspect ratio (DFAR),femoral component fit,and clinical outcomes at 2 years after total knee arthroplasty (TKA).Methods From December 2012 to December 2014,the clinical and radiographic characteristics of 107 consecutive patients (109 knees) were studied prospectively.All patients were divided into two groups according to gender:33 cases (33 knees) were male and 74 cases (76 knees) were female.These subjectives underwent unilateral primary TKAs for end-stage osteoarthritis by using Vanguard high-flex open-box posterior-stabilized fixed-bearing prosthesis.The anterior-posterior size increment of the Vanguard femoral components was 2 mm.The clinical outcomes (Knee Society Score,Western Ontario and McMasters University osteoarthritis index,time-up-to-go test,chair rise test,stair-climbing test,range of flexion,extensor lag,flexion contracture,anterior knee pain score and patient satisfaction) between two groups were compared at 2 years postoperatively.The femoral component fit and two kinds of DFARs were also compared intraoperatively.Results The total overhang value in zone 2 was-5.51±4.46 mm in male and-3.24±3.93 mm in female,respectively.That in zone 3 was-5.99±4.73 mm in male and-3.45±3.98 mm in female.The total underhang value in male was significantly higher than that in female (P＜0.05).The rate of significant underhang in zone 3 was significantly higher in male than that in female (60.6％,23.7％,P＜O.05).Two kinds of DFARs in male were significantly higher than those in female (1.56±0.12 vs.1.51±0.12,1.28±0.08 vs.1.24±0.11,P＜0.05).Compared with intra-operative range of flexion (ROF) in the condition of 90° hip flexion after prosthesis implantation,the loss of ROF against gravity and the loss of passive ROF at 2 years postoperatively were statistically significant higher than those in female (-8.73°±7.71° vs.-4.82°±6.67°,-11.45°±8.78° vs.-7.34°±8.71°,P＜0.05).In the male group,the natural ROF after capsule closed (132.85°±6.01°) was significantly larger than that of the female group (128.78°±6.34°),but there was no significant difference in passive flexion.The change of non-weight-bearing passive ROF (1.67°± 14.76°),the Knee Society stairclimbing score (45.15±7.12) and the proportion of being able to squat and rise (97.0％) in male group were greater than those in female group,postoperatively.Conclusion Although DFAR is different within gender;it has little effects on early outcomes after unisex posterior-stabilized TKA.The loss of ROF in male is more prominent than that in female.Increased size offerings of femoral components improve fit in female distal femur.However,distal femur of male still exist obvious underhang.

Objective To compare the effect of preservation or complete excision of infrapatellar fat pad (IPFP) on clinical outcomes after total knee arthroplasty (TKA) at one year follow-up.Methods We randomized 100 patients (100 knees) undergoing TKA into two groups from June 2014 to August 2015,16 male and 78 female,with the average of 62.37 years old (range from 48 to 75).In excision group,50 patients underwent TKA with complete IPFP excision and in preservation group,50 patients received TKA without IPFP excision.We compared the outcome at postoperative 1 year between the two groups.Wound complication rate and patellar tendon injury rate were also evaluated.Results Complete follow-up data were available on 94 patients (46in preservation group and 48 in excision group).There were no intraoperative patellar tendon injury and postoperative wound complication cases.The patellar tendon length of excision group and preservation group at 1 week was (40.35±6.05) mm and (40.56±6.17) mm,and at 1 year were (36.18±7.09) mm and (38.75±6.23) mm,there were no statistical differences between the two groups.The patellar tendon shortening at postoperative 1 year in excision group was (-4.18±3.52) mm,more than preservation group which was (-1.81±2.08) mm,and there was statistically significant difference between the two groups.One year postoperatively,the anterior knee pain score in preservation group 2.42±2.19 was lower than excision group excision group 0.93± 1.40,and anterior knee pain rate was 2.2％ and 18.8％ in each group,the difference were all statistically significant.The Knee Society (KS) scores,knee flexion,flexion contracture,patient satisfaction score,and patient satisfaction rate had no statistical differences between the two groups.Conclusion Complete resection of IPFP results in a significant patellar tendon shortening and a higher probability of occurrence of knee pain after 1 year of TKA.Retention of IPFP did not increase the risk of patellar tendon injury and should therefore be kept as much as possible for complete IPFP.

Objective To investigate the mental health states of health system staffs in a district of Chongqing municipality. Methods Seven hundred and seventy-three health system staffs were taken as the research subjects for conducting the investigation by the Symptoms Checklist-90 (SCL-90).With the total SCL-90 score >160 as the positive psychological symptom,the total mean scores of SCL-90 and the 9 items of factor score of somatization,obsession,personal relations,depression,anxiety,hostility,dread, paranoid and psychotics were performed the statistical analysis.Results The positive rate of psychological symptoms in 773 health system staffs was 17.46% (135/773),among them which in the clinical nurses,clinicians and nonclinical staffs were 23.20%(58/250),15.63%(50/320)and 13.30%(27/203)respectively.The somatization and obsession scores of the health system staffs in this district were obviously higher than those of the national norm (P <0.05),while their personal relations and paranoid scores were obviously lower than those of the national norm(P <0.01).The paranoid scores of the staffs in the district health units were higher than those of the staffs worked in town health units(P <0.05),and other 8 items of factor score and the total mean scores were significantly higher than those in the town health unit staffs (P <0.01).The scores of obsession,depression,anxiety,hostility and the total mean scores of the clinical nurses were significantly higher than those of the clinicians (P <0.01),while scores of so-matization,personal relations,paranoid and psychotics had no significant differences between them(P > 0.05).The total mean scores of the clinical nurses were higher than those of the non-clinical staffs(P <0.05).Conclusion The scores of multiple factors had significant differences between the health system staffs in this district and the national norm.The psychological health status in the clinicians was poorer than that in the non-clinical staffs,especially the psychological health status in the clinical nurses were much poorer.