Abstract:Objective To investigate the clinical characteristics and causes of misdiagnosis of Lambert-Eaton myasthenic syndrome(LEMS).Methods A retrospective analysis was performed on the clinical data of a LEMS patient misdiagnosed with motor neuron disease(MND)in 2024.Results The male patient presented with bilateral lower limb weakness for over 4 years without obvious cause.An ultrasound of the lower limb arteries at another hospital revealed occlusion of the right femoral artery,leading to vascular bypass grafting.Postoperatively,the bilateral lower limb weakness gradually worsened.After admission,magnetic resonance imaging(MRI)and neuroelectrophysiological examinations suggested a possible diagnosis of MND.Further investigations,including repetitive nerve stimulation(RNS)and tumor marker tests,confirmed the diagnosis of small cell lung cancer and LEMS.The misdiagnosis lasted over 4 years.The patient received no further treatment after the diagnosis.Conclusion LEMS is rare in clinical practice and prone to misdiagnosis.Clinicians should enhance their understanding of the epidemiological and electrophysiological features of the disease.For suspected patients,RNS should be promptly conducted to minimize or avoid misdiagnosis.

Abstract:Objective To investigate the effect of closed reduction and cannulated screw fixation via a 3D-printed guide in the treatment of elderly patients with osteoporotic calcaneal fracture and its effect on postoperative early pain and complications.Methods A total of 98 elderly patients with osteoporotic calcaneal fractures admitted from May 2023 to April 2024 were selected and divided into the observation group and the control group by random number table method,with 49 patients in each group.The control group was treated with open reduction and internal fixation with lateral L-shaped incision,and the observation group was treated with closed reduction and cannulated screw fixation via a 3D-printed guide.The operation-related indexes,imaging indexes before and after operation,pain mediators[prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT),substance P]levels before operation,and at 1 d,3 d and 7 d after operation,incidence of soft tissue complications and Marland score of foot function at 1 year after operation were compared between the two groups.Results The number of X-ray fluoroscopy and blood loss in the observation group were less than those in the control group,and the duration of operation and length of postoperative hospital stay were shorter than those in the control group(P＜0.05).The calcaneal height and Böhler angle of the two groups after operation were higher than those before operation,while the calcaneal width and Gissane angle were lower than those before operation(P＜0.05).The levels of serum PGE2,5-HT and substance P in the observation group were lower than those in the control group at 1,3 and 7 d after operation(P＜0.05).The incidence of soft tissue complications in the observation group[0(0/49)]was lower than that in the control group[18.37％(9/49)](P＜0.05).At 3 months after operation,the Marland score of the observation group was higher than that of the control group,and the Marland classification was better than that of the control group(P＜0.05).There was no significant difference in Marland score and Marland classification between the two groups at 12 months after operation(P＞0.05).Conclusion The short-term efficacy of closed reduction and cannulated screw fixation via a 3D-printed guide is comparable to that of open reduction and internal fixation,but it has lower requirements for soft tissue,less postoperative pain,fewer soft tissue complications,and faster postoperative recovery.

Abstract:Objective To investigate the impacts of ultrasound-guided stellate ganglion block(SGB)combined with general anesthesia on hemodynamics,stress response,and inflammatory factor levels in patients undergoing laparoscopic cholecystectomy(LC).Methods Eighty patients admitted from June 2022 to December 2023 for LC were selected,and divided into the control group(n=40)and the observation group(n=40),using a random number table method.The control group received general anesthesia,while the observation group received ultrasound-guided SGB and general anesthesia.The hemodynamic indicators,stress response,inflammatory factor levels,and postoperative pain were compared between the two groups during the perioperative period[upon entering the anesthesia preparation room(T0),at 5 min after SGB(T1),immediately after intubation(T2),immediately after establishing pneumoperitoneum(T3),and immediately after surgery(T4)].Results At T0-T4,both groups showed a trend of first decreasing and then increasing in heart rate and mean arterial pressure(MAP)(P＜0.01),and at T1-T4,the heart rate and MAP of the observation group were more stable than those of the control group(P＜0.05,P＜0.01).At T2-T4,the levels of cortisol and adrenocorticotropic hormone(ACTH)in both groups increased compared with those at T0,and the increase in the observation group was smaller than that in the control group(P＜0.05,P＜0.01).At T2-T4,the levels of C reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in both groups increased compared with those at T0,which were lower in the observation group than in the control group(P＜0.01).Immediately after anesthesia recovery,and at 12,24,48,and 72 after surgery,visual analog scale(VAS)pain scores in both groups showed a trend of initial increase and then decrease(P＜0.01),and the VAS scores of the observation group were lower than those of the control group(P＜0.01).Conclusion Ultrasound-guided SGB combined with general anesthesia can effectively alleviate stress response,reduce hemodynamic fluctuations,and lower levels of inflammatory factors in patients undergoing LC.

Abstract:Objective To observe the application effect of Dexamethasone and Tropisetron alone and in combination in preventing postoperative nausea and vomiting(PONV)in elderly patients undergoing thoracolumbar spinal surgery under general anesthesia.Methods A total of 450 patients undergoing thoracolumbar spinal surgery under general anesthesia from September 2023 to March 2025 were selected and divided into Dexamethasone group(n=150),Tropisetron group(n=150)and combination group(n=1 50)by envelope random method.Before induction of general anesthesia,Dexamethasone group was injected with Dexamethasone,Tropisetron group was injected with Tropisetron,and combination group was injected with Dexamethasone and Tropisetron.The incidence of PONV,the administration of Metoclopramide,the visual analogue scale(VAS)pain score and the dosage of postoperative analgesics were compared among the three groups at different time points after operation.Results The total incidence of PONV in the combination group was lower than that in the Dexamethasone group and the Tropisetron group at 0-1,1-6,6-12,12-24,and 24-48 h after operation(P＜0.05).The administration rate of Metoclopramide in combination group was lower than that in Dexamethasone group and Tropisetron group at 0-1 h,1-6 h,6-12 h and 12-24 h after operation(P＜0.05).Compared with those at 1 h after operation,the VAS pain scores of pain at 6,12,24 and 48 h after operation in the three groups were decreased,and the VAS pain scores at 1,6,12 and 24 h after operation in the combination group were lower than those in the Dexamethasone group and the Tropisetron group(P＜0.05).The postoperative dosage of Sufentanil was(35.92±5.69)μg in Dexamethasone group,(35.15±5.41)μg in Tropisetron group,and(34.44±6.27)μg in combination group.There was no significant difference in the dosage of Sufentanil among the three groups(P＞0.05).Conclusion The combined use of Dexamethasone and Tropisetron can significantly reduce the incidence of PONV,the administration rate of Metoclopramide and postoperative pain in elderly patients undergoing thoracolumbar spinal surgery under general anesthesia,without significant influence on postoperative dosage of analgesics.

Abstract:Objective To investigate the effect of Anshen Dingzhi formula on insomnia with heart-spleen deficiency syndrome.Methods From January 2020 to January 2023,86 insomnia patients with heart-spleen deficiency syndrome were selected.According to the random number table method,they were divided into the observation group and the control group,with 43 patients in each group.Both groups were given basic treatment for insomnia.The control group was treated with Estazolam tablets,and the observation group was treated with traditional Chinese medicine(TCM)Anshen Dingzhi formula.Both groups were treated for 4 weeks.The TCM syndrome score,Pittsburgh Sleep quality Index(PSQI)score,sleep dysfunction rating scale(SDRS)score,serum levels of 5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA),norepinephrine(NE)and total effective rate were compared between the two groups before and after treatment.Results Compared with those before treatment,the TCM syndrome scores after treatment were decreased in the two groups,which were lower in the observation group than in the control group(P＜0.05).After treatment,the PSQI scores and SDRS scores of the two groups were lower than those before treatment,and lower in the observation group than in the control group(P＜0.05,P＜0.01).After treatment,the levels of serum 5-HT and GABA in the two groups were higher than those before treatment,while the level of NE was lower than that before treatment(P＜0.05).After treatment,the serum levels of 5-HT and GABA in the observation group were higher than those in the control group,while the NE level was lower than that in the control group(P＜0.01).The total effective rate of the observation group[97.67％(42/43)]was higher than that of the control group[74.42％(32/43)](P＜0.01).The total incidence of adverse reactions in the observation group was lower than that in the control group(P＜0.05).Conclusion Anshen Dingzhi formula can reduce TCM syndrome scores,improve sleep quality,alleviate sleep disorders,and have a significant effect on treating insomnia with heart-spleen deficiency syndrome.Its mechanism may be related to regulating the levels of 5-HT,GABA,and NE.

Abstract:Objective To investigate the clinical characteristics of elderly female patients with diabetes mellitus(DM)complicated by synovitis,acne,pustulosis,hyperostosis,osteitis(SAPHO)syndrome,who presented with bone pain as the chief complaint.Methods The clinical data of one elderly female patient with SAPHO syndrome,who was admitted in 2023 and had been misdiagnosed as other diseases previously,was retrospectively analyzed.Results An elderly patient was admitted to the hospital primarily due to generalized pain lasting for 14 years,which had worsened over the past month.The patient had been repeatedly misdiagnosed with cervical spondylosis,lumbar spondylosis,osteoporosis,osteoarthritis,gout,diabetic peripheral neuropathy,and other conditions,but symptomatic treatment yielded no satisfactory results.After admission,based on a comprehensive analysis of the patient's clinical manifestations(including bone pain and pustular rash)and whole-body bone scintigraphy findings showing tracer concentration at the bilateral first costosternal junctions and sternal angle,the diagnosis of SAPHO syndrome was confirmed.The duration of misdiagnosis was 14 years.Following the initiation of immunomodulatory therapy after confirmation,the patient's condition improved significantly.During the follow-up period,the patient's pain-related symptoms were significantly improved compared with the baseline status.Conclusion SAPHO syndrome has diverse etiologies and is prone to missed diagnosis and misdiagnosis,requiring careful clinical differentiation.The disease lacks specific clinical manifestations,and early symptoms are often atypical.Enhancing the understanding of this disease and raising clinical vigilance are conducive to early diagnosis and prompt treatment.

Abstract:Objective To investigate the clinical efficacy of traditional Chinese medicine(TCM)fumigation and washing and high-intensity focused ultrasound in the treatment of vulvar leukoplakia with damp-heat downward infusion syndrome.Methods From December 2021 to December 2022,the clinical data of patients with vulvar leukoplakia with damp-heat downward infusion syndrome were retrospectively analyzed.According to the treatment method,the patients were divided into ultrasound treatment group(n=97)and combination treatment group(n=103).The ultrasound treatment group was treated with high-intensity focused ultrasound,and the combination treatment group was treated with high-intensity focused ultrasound combined with TCM.The clinical effects and adverse reactions of the two groups were compared.The improvement of skin symptoms(vulvar pruritus,vulvar depigmentation,vaginal pain),inflammatory factor levels[hypersensitive C reactive protein,interleukin-6,procalcitonin]and quality of life[dermatology life quality index]were compared before treatment and at 1 month after treatment,and the recurrence after treatment in the two groups was recorded.Results The total effective rate in combination treatment group was higher than that in ultrasound treatment group(P＜0.05).During treatment,there were no significant differences in the total incidence rates of adverse reactions between the two groups(P＞0.05).At 1 month after treatment,the skin symptom improvement score,inflammatory factor levels and DLQI score in both groups were significantly declined compared with those before treatment,which were lower in combination treatment group than in ultrasound treatment group(P＜0.05,P＜0.01).At 6 months,1 year and 2 years after treatment,the recurrence rate was lower in combination treatment group than in ultrasound treatment group(P＜0.05,P＜0.01).Conclusion TCM fumigation and washing combined with high-intensity focused ultrasound has significant efficacy in the treatment of vulvar leukoplakia with damp-heat downward infusion syndrome,and it can effectively relieve the clinical symptoms and skin symptoms of patients,reduce the levels of inflammatory factors and enhance the quality of life of patients,with good safety.

Abstract:Objective To investigate clinical efficacy of ankle arthrodesis assisted with 3D printing technology in advanced traumatic ankle arthritis.Methods A total of 88 patients with advanced traumatic ankle arthritis treated between February 2022 and February 2024 were enrolled.According to different treatment methods,they were divided into group A(n=43,traditional ankle fusion)and group B(n=45,traditional ankle fusion assisted with 3D printing technology).Group A was treated with traditional ankle arthrodesis,and group B was treated with traditional ankle arthrodesis assisted with 3D printing technology.The duration of operation,intraoperative blood loss,length of hospital stay,scores of American orthopedic foot and ankle society(AOFAS)and visual analogue scale(VAS)pain score before and after surgery were compared,and postoperative bone fusion rate and incidence of complications were recorded between the two groups.Results The duration of operation and length of hospital stay in group B were shorter than those in group A,and intraoperative blood loss was less than that in group A(P＜0.01).At 1 month,3 months,6 months and 1 year after surgery,AOFAS scores were increased in both groups(P＜0.05),as compared with those before surgery,which were higher in group B than in group A(P＜0.01).At 7 d and 15 d after surgery,VAS scores were decreased in both groups,as compared with those before surgery,which were lower in group B than in group A at 15 d after surgery(P＜0.01).At 6 months after surgery,bone fusion rate in group B was higher than that in group A(P＜0.01),and at 1 year after surgery,there was no significant difference in bone fusion rate between the two groups(P＞0.05).The total incidence of postoperative complications in group B was lower than that in group A[4.44％(2/44)vs.18.60％(8/43),P＜0.05].Conclusion Ankle arthrodesis assisted with 3D printing technology can shorten the duration of operation,promote postoperative ankle rehabilitation,increase bone fusion rate,relieve postoperative pain and reduce the incidence of complications.

Abstract:Objective To investigate the effects of Shugan Tiaoshen acupuncture combined with auricular point therapy on depression severity and serum levels of interleukin-1 β(IL-1β),C reactive protein(CRP)and interleukin-6(IL-6)in patients with post-cerebral infarction depression(PCID)and spleen deficiency and liver depression syndrome.Methods In total,103 patients with PCID admitted between March 2022 and March 2024 were selected and divided into the control group(n=52)and the observation group(n=51)according to random number table method.The control group was given auricular point therapy combined with sham acupuncture,while observation group was supplemented with Shugan Tiaoshen acupuncture.The clinical therapeutic effect in the two groups was observed.The depression severity[Hamilton depression scale-17(HAMD-17)],cognitive function[mini-mental state examination(MMSE)],nerve function[national institutes of health stroke scale(NIHSS)],levels of serum inflammatory factors(CRP,IL-1β,IL-6)and brain-related biomarkers[brain-derived neurotrophic factor(BDNF),glial fibrillary acidic protein(GFAP),S100B protein],and the safety were compared between the two groups before and after treatment.Results The total response rate of observation group was higher than that of control group[90.20％(46/51)vs.71.15％(37/52),P＜0.05].After treatment,scores of HAMD-17 and NIHSS were decreased in both groups,which were lower in the observation group than in the control group(P＜0.05,P＜0.01).After treatment,MMSE score and BDNF level were increased in both groups,which were higher in the observation group than in the control group(P＜0.05,P＜0.01).After treatment,levels of CRP,IL-1β,IL-6,GFAP and S100B were decreased in both groups,which were lower in the observation group than in the control group(P＜0.05,P＜0.01).There was no significant difference in total incidence of adverse reactions between the two groups during treatment(P＞0.05).Conclusion Shugan Tiaoshen acupuncture combined with auricular point therapy can effectively improve depressive symptoms and nerve function in patients with PCID and spleen deficiency and liver depression syndrome,regulate levels of serum inflammatory factors and brain-related biomarkers,with good safety.

Abstract:Ulcerative colitis(UC)is one of the intractable diseases in the digestive system.Professor Li Diangui,a master of traditional Chinese medicine(TCM),was the first to systematically propose the Turbid Toxin Theory,which provides a new theoretical basis for the TCM syndrome differentiation and treatment of UC.To further clarify the pathogenic mechanism of turbid toxin and guide clinical practice,this study systematically summarizes the clinical experience and mechanism of treating UC based on the Turbid Toxin Theory.Based on this theoretical framework,and focusing on the characteristics of turbid toxin,which is persistent and difficult to eliminate,consuming qi and damaging blood,weidentified the core pathogenesis of UC as turbid toxin obstructing the intestines and disrupting disharmony between qi and blood",and proposed"resolving turbid toxin and harmonizing qi and blood"as the basic therapeutic principles for UC.In clinical practice,the treatment is based on self-formulated prescriptions including the Liqi Huazhuo formula(Qi-Regulating and Turbid-Removing Formula),Quyu Huazhuo formula(the Stasis-Resolving and Turbid-Removing Formula,and Heying Huazhuo formula(the Nutrient-Harmonizing and Turbid-Removing Formula).Medication is refined and modified according to the specific symptoms of patients,so as to better guide clinical practice and improve the therapeutic efficacy.

Abstract:Objective To investigate the intervention effect of Group Field Zhanzhuang Qi-Regulation Therapy on sub-healthy individuals and patients with chronic disease.Methods From January 2022 to April 2024,a questionnaire-based survey was conducted to investigate the health status of individuals who had continuously participated in the Group Field Zhanzhuang Qi-Regulation Therapy for one month or longer.A total of 632 valid questionnaires were collected.Improvements in the subhealth status of participants were observed before and after practicing the therapy.Results After practicing the therapy,of all participants in the Group Field Zhanzhuang Qi-Regulation Therapy,75.95％reported a marked increase in appetite,76.27％experienced improved bowel movements,and the effective rates for boosting energy levels and enhancing emotional state both reached 92.56％.Among patients with nodular diseases,50.96％experienced a reduction in nodule size,6.94％achieved complete nodule resolution,and 42.10％showed no change in nodule size.For patients with pain-related conditions,78.70％reported significant pain relief,5.56％achieved complete disappearance of pain symptoms,and 15.74％showed no improvement.After practicing the therapy,blood pressure,glycemic control rates,insomnia,and anxiety-depression symptoms all showed significant improvement,with significant differences compared with those before practicing the therapy(P＜0.01);the frequency of upper respiratory infections and hospitalizations was significantly reduced(P＜0.01).Conclusion Persistent practice of Group Field Zhanzhuang Qi-Regulation Therapy can effectively improve the sub-health status of the patient,and reduce the occurrence of chronic diseases.

Abstract:Objective To investigate the efficacy of different doses of intravenous immunoglobulin(IVIG)combined with Aspirin in the treatment of Kawasaki disease(KD)in children and its effect on coronary artery Z values vascular endothelial function,and coagulation function.Methods A total of 206 children with KD who were hospitalized from May 2020 to May 2023 were enrolled as the study subjects,and were grouped by the random number table method,with 103 patients in each group.Both groups were treated with Aspirin,the control group was supplemented with low-dose IVIG on this basis,and the observation group was supplemented with high-dose IVIG.The treatment period was 3 weeks,and clinical efficacy,coronary artery Z values,vascular endothelial function and coagulation function,and inflammatory factor levels before and after treatment,as well as the time to resolution of clinical symptoms and signs,and the incidence of adverse reactions,were compared between the two groups.Results The total clinical efficacy in the observation group was higher than that in the control group(P＜0.05).After treatment,the coronary artery Z values were significantly higher than those before treatment,while the non-flow mediated dilation(NMD)and brachial artery blood flow-mediated dilation(FMD)were significantly higher than those before treatment(P＜0.05).Compared with the control group,the observation group showed reduced coronary artery Z values and increased NMD and FMD after treatment(P＜0.05,P＜0.01).There was no significant difference in activated partial thromboplastin time between the two groups before and after treatment(P＞0.05).After treatment,the levels of D-dimer(D-D),white blood cell count(WBC),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in both groups were lower than those before treatment(P＜0.05).The levels of D-D,WBC,CRP,and ESR in the observation group after treatment were lower than those in the control group(P＜0.05,P＜0.01).The time to resolution of clinical symptoms and signs in the observation group was shorter than that in the control group(P＜0.05).In addition,there were no significant differences in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion High-dose IVIG combined with Aspirin for children with KD has a more significant efficacy,which can rapidly reduce inflammatory response,improve vascular endothelial function,coagulation function and coronary artery lesions,shorten the course of the disease,and has good safety.

Abstract:Under specific conditions,bacteria or fungi within the human commensal microbiota can become opportunistic pathogens,leading to infectious diseases.Opportunistic pathogens related to other parts of the body can also cause changes in the ocular surface microenvironment,resulting in infectious eye diseases,and in severe cases,endophthalmitis may even occur.Opportunistic pathogens often exhibit resistance to most conventional antibiotics,and are associated with poor prognosis.These infections may trigger severe secondary infections,impair visual function,and even lead to other irreversible consequences.This study reviews the early identification and treatment strategies for opportunistic pathogens in ocular infections,aiming to provide a basis for clinical empirical therapy.

Abstract:Objective To compare the clinical efficacy of InterTAN intramedullary nailing and proximal femoral nail antirotation(PFNA)nailing in the treatment of intertrochanteric fracture(IFF).Methods Sixty patients with IFF admitted to our hospital from January 2020 to August 2021 were retrospectively analyzed.According to the operation method,the patients were divided into PFNA group and InterTAN group,with 30 patients in each group.The PFNA group was treated with PFNA nailing,and the InterTAN group was treated with InterTAN intramedullary nailing.The perioperative indicators and pain severity were compared between the two groups.The Harris hip score before operation and at 3,6,and 12 months after operation,the reduction quality at 3 months after operation,and the postoperative complications of the two groups were followed up and recorded.Results The duration of operation of PFNA group was shorter than that of InterTAN group,the intraoperative blood loss was less than that of InterTAN group,and the fracture healing time was longer than that of InterTAN group(P＜0.05,P＜0.01).With the extension of postoperative time,the visual analogue scale(VAS)pain scores of the two groups showed a downward trend,and the VAS scores of the InterTAN group were lower than those of the PFNA group at 1 and 3 d after operation(P＜0.05,P＜0.01).At 3 and 6 months after operation,the Harris scores of InterTAN group were higher than those of PFNA group(P＜0.01).At 6 months after operation,the excellent and good reduction rate in InterTAN group[96.67％(29/30)]was higher than that in PFNA group[76.66％(23/30)](P＜0.05),while the total incidence of complications in InterTAN group[10.00％(3/30)]was lower than that in PFNA group[36.66％(11/30)](P＜0.05).Conclusion InterTAN intramedullary nailing can effectively promote the recovery of hip function in patients with IFF,reduce their postoperative pain,improve the quality of reduction,with good stability and high safety.

Abstract:Objective To analyze the influencing factors and predictive value of root canal therapy(RCT)failure in patients with misdiagnosed residual pulpitis.Methods Clinical data of 97 patients with misdiagnosed residual pulpitis who underwent RCT from March 2022 to February 2024 were retrospectively analyzed.According to the results of RCT outcomes,the patients were divided into the successful treatment group(n=79)and the failure group(n=18).The general data of the two groups were compared.The statistically significant indicators were included in the multivariate logistic regression model to analyze the influencing factors and predictive value of RCT failure.Results There were significant differences in the location of the affected tooth,crown restoration after RCT,pulp condition,apical lesion,tight root canal filling,and cracked root canal between the two groups(P＜0.05).Further multivariate Logistic regression analysis showed that the location of the affected tooth and the condition of the pulp were the main factors affecting RCT failure in patients with misdiagnosed residual pulpitis(P＜0.05).According to the combined data fitted by multivariate Logistic regression coefficients,the receiver operating characteristic(ROC)curve analysis for predicting treatment failure showed that the area under the ROC curve was 0.893,with the sensitivity and specificity of 83.3％and 91.1％,respectively,the prediction accuracy of 68.2％,the recall rate of 83.3％,and the predicted probability of 0.820.Conclusion Tooth location and pulp status are key factors affecting RCT outcomes in patients with misdiagnosed residual pulpitis,warranting heightened clinical attention.The risk prediction model developed from this study demonstrates high predictive value for RCT failure.

Abstract:Objective To investigate the effect of preoperative oral administration of Dextroprofen on postoperative pain and sleep quality in children undergoing vital pulpotomy combined with preformed crown restoration.Methods A total of 82 children with homonymous teeth who underwent vital pulpotomy combined with preformed crown restoration from January 2023 to November 2024 were selected as the research subjects.They were divided into the observation group(n=41)and the control group(n=41)by random number table method.Both groups were treated with vital pulpotomy combined with preformed crown restoration.The control group was given oral placebo 15 min before operation,and the observation group was given oral Dextroprofen 15 min before operation.Both groups were given conventional analgesia after operation.The degree of pain at different time points after operation[FLACC(Face,Legs,Activity,Cry,Consolability)behavioral pain scale,visual analogue scale(VAS)pain score],Pittsburgh sleep quality index(PSQI)score,emotional state[modified dental anxiety scale(MDAS),Chinese version of children's fear survey-dental subscale(CFSS-DS)score],behavior change and analgesic drug use at 3 d after operation were compared between the two groups.Results The FLACC behavioral pain scale score and VAS pain score of the two groups increased first and then decreased at 1-24 h after operation(P<0.05).The FLACC behavioral pain scale score and VAS pain score of the observation group were lower than those of the control group at 3,6,12 and 24 h after operation(P<0.05).At 24 h after operation,the scores of each dimension of PSQI,MDAS,CFSS-DS and the incidence of behavioral changes in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the use rate of analgesic drugs between the two groups at 3 d after operation(P>0.05).Conclusion Oral administration of Dexibuprofen at 15 min before operation in children undergoing vital pulpotomy combined with preformed crown restoration can reduce postoperative pain and behavioral changes,and improve emotional state and sleep quality,without affecting the use of postoperative analgesic drugs.

Abstract:Objective To explore the impact of laparoscopic hepatectomy assisted with precise hepatic pedicle dissection technique on clinical efficacy and serum γ-glutamyl transferase(γ-GT)and alpha-fetoprotein(AFP)in patients with primary liver cancer.Methods A total of 96 patients with primary liver cancer undergoing surgical treatment in the hospital were retrospectively enrolled between October 2018 and October 2020.According to different surgical methods,they were divided into the control group(n=50,conventional laparoscopic hepatectomy)and the observation group(n=46,laparoscopic hepatectomy assisted with precise hepatic pedicle dissection).The surgical parameters,liver function indexes,inflammatory markers and negative conversion ratio of serum AFP in the two groups were compared before and after treatment.The incidence of complications was recorded,and prognosis at 1 year after surgery was evaluated.Results Compared with the control group,intraoperative blood loss and postoperative drainage volume were lower,and length of hospital stay was shorter in the observation group(P<0.01).There was no significant difference in duration of operation between the two groups(P>0.05).At 7 d after surgery,levels of serum aspartic transaminase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),γ-GT,interleukin(IL)-6,C-reactive protein(CRP)and tumor necrosis factor(TNF)-α were decreased in both groups,which were lower in the observation group(P<0.05).At 7 d after surgery,negative conversion rate of AFP in the observation group was higher than that in the control group[86.96%(40/46)vs.68.00%(34/50),P<0.05].At 1 year after surgery,recurrence rate in the observation group was lower than that in the control group,while overall survival rate and progression-free survival rate were higher than those in the control group(P<0.05).Conclusion The application of laparoscopic hepatectomy assisted with precise hepatic pedicle dissection can promote recovery of liver function,reduce level of serum γ-GT,increase negative conversion rate of AFP,alleviate inflammatory response,reduce complications and improve prognosis of patients with primary liver cancer.

Abstract:Objective To investigate the efficacy of repeat transurethral resection(reTUR)for high-risk non-muscle-invasive bladder cancer(NMIBC)after transurethral bladder tumor resection and influencing factors of recurrence.Methods A retrospective analysis was conducted on the clinical data of 108 patients with high-risk NMIBC from June 2021 to December 2022.These patients were divided into the reTUR group(n=50)and the non-reTUR group(n=58)based on whether they received reTUR.All patients received conventional chemotherapy and regular follow-ups after surgery.The therapeutic effects,tumor recurrence,and recurrence-free survival period(RFS)of the two groups were compared.According to the patients'recurrence status,they were divided into the recurrence group(n=44)and the non-recurrence group(n=64).The influencing factors of tumor recurrence after high-risk NMIBC surgery were analyzed.Results The total effective rate of the reTUR group was 86.00%(43/50),which was higher than that of the non-reTUR group[68.97%(40/48)](P<0.05).The follow-up ended in December 2024.The total recurrence rate of the reTUR group was 28.00%(14/50),which was lower than that of the non-reTUR group at 51.72%(30/58),and the RFS was longer than that of the non-reTUR group(P<0.05).Through binary logistic regression analysis,the number of tumors≥2,tumor stage T1,and tumor grade G3 were all independent influencing factors of postoperative recurrence in high-risk NMIBC patients,while reTUR was the protective factor(P<0.05).Conclusion For patients with high-risk NMIBC who underwent reTUR for bladder tumor,further reTUR treatment can significantly improve the therapeutic effect and reduce the recurrence rate.The number of tumors,tumor stage,tumor grade and reTUR can all affect the recurrence of high-risk NMIBC patients.

Abstract:Objective To investigate the clinical efficacy and surgical safety of modified tibialis posterior tendon reconstruction in the treatment of type Ⅱ painful accessory navicular bone.Methods A total of 61 patients with type Ⅱ painful accessory navicular bone who were admitted from August 2021 to August 2023 were retrospectively included.According to the surgical methods adopted by the patients,they were divided into two groups,Group A and Group B.Group A was treated with modified tibialis posterior tendon reconstruction(excision of the accessory navicular bone and reconstruction of the posterior tibial tendon with suture anchors),while Group B underwent Kidner surgery.The preoperative and final follow-up scores of the American Orthopedic Foot and Ankle Society(AOFAS)midfoot scale,the Visual Analogue Scale(VAS)pain score,and radiographic parameters were compared between the two groups.The serum inflammatory indicators at 3 d after surgery and the time to complete weight-bearing after surgery were also compared,and the occurrence of complications was observed.Results The postoperative follow-up period for all patients ranged from 12.1 to 18.8(15.6±3.1)months,with no patients lost to follow-up.At the end of the follow-up,the VAS pain scores of both groups were lower than those before surgery,and the AOFAS midfoot scale score was higher than that before surgery.The calcaneal pitch angle,talar tilt angle,talo-first metatarsal angle,anteriorposterior talo-first metatarsal angle,and talonavicular coverage angle all improved compared with those before the surgery(P<0.05).Before the surgery and at the end of the follow-up,there was no significant difference in VAS pain score,AOFAS midfoot scale score,and radiographic parameters between the two groups(P>0.05).At 3 d after the surgery,there was no significant difference in serum C-reactive protein,interleukin-1β,interleukin-6,and tumor necrosis factor-α levels between the two groups(P>0.05).The postoperative complete weight-bearing time of group A was(12.00±1.00)weeks,which was shorter than that of group B[(13.00±1.64)weeks](P<0.05).Neither group had nerve or vascular injuries.Except for one case in group B that developed incision infection on the 7th day after the surgery,all incisions healed smoothly.Conclusion The modified tibialis posterior tendon reconstruction,as well as the traditional Kidner surgery for treating type Ⅱ painful accessory navicular bones,can all alleviate the pain symptoms of patients and improve the function of the affected foot,showing high surgical safety.However,the complete weight-bearing time of the former is shorter than that of the latter,and it has certain advantages.

Abstract:Objective To explore the relationship between chest CT imaging features and pulmonary function in children with Mycoplasma pneumoniae pneumonia(MPP),and to analyze its predictive value for poor prognosis,so as to provide reference for clinical diagnosis and treatment.Methods A total of 120 children with MPP admitted from January 2021 to February 2024 were selected and divided into mild group(n=53)and severe group(n=67)according to the severity of the disease.The chest CT imaging features and pulmonary function indexes[percentage of predicted forced vital capacity(FVC%),percentage of predicted forced expiratory volume in the first second(FEV1%),respiratory rate(RR),tidal volume(VT),time to peak expiratory flow to total expiratory time ratio(TPTEF/TE),volume to peak expiratory flow to total expiratory volume ratio(VPTEF/VE)(VPTEF/VE)]were compared between the two groups,and the relationship between chest CT imaging features and pulmonary function was analyzed.The chest CT imaging features of MPP children with different prognoses were compared,and their predictive value for poor prognosis was analyzed.Results The incidence rates of ground-glass opacities(GGO),reticular opacities,large patchy consolidations and chest CT score in the mild group were lower than those in the severe group(P<0.05).The FVC%and FEV1%,VT,TPTEF/TE,and VPTEF/VE in the mild group were all higher than those in the severe group,while the RR was lower in the mild group than in the severe group(P<0.05).Children with MPP who had GGO,reticular opacities,and large patchy consolidations had lower FVC%,FEV1%,VT,TPTEF/TE,and VPTEF/VE compared with those without GGO,reticular opacities,and large patchy consolidations,while the RR was higher in these children than in those without GGO,reticular opacities,and large patchy consolidations(P<0.05).After one course of treatment,the prognosis was evaluated.Of them,41 patients were included in the poor prognosis group and 79 patients were included in the good prognosis group.The incidence of GGO,reticular opacities,large patchy consolidations and chest CT score in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the combination of GGO,reticular opacities,large patchy consolidations and chest CT score had the largest area under the curve for predicting poor prognosis in children with MPP,which was 0.889(95%CI:0.819,0.939),with a sensitivity of 85.37%and a specificity of 77.22%.Conclusion The imaging features of chest CT in children with MPP are closely related to pulmonary function.The combination of GGO,reticular opacities,large patchy consolidations and chest CT score has a high value in predicting the risk of poor prognosis in children.