Table of Content

21 October 2024, Volume 45 Issue 5

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Current status of clinical application of intelligent orthopedics

Wang Junqiang, Jiang Xieyuan

2024, 45(5):  741-743.  doi:10.3969/j.issn.1006-7795.2024.05.001

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Intelligent orthopaedics is a novel direction for the development of modern orthopaedics. It is also a key area for the clinical transformation of the world's current cutting-edge medical science and technology. At this stage, the clinical application research of intelligent orthopaedics focuses on intelligent medical engineering and intelligent medical treatment. Orthopaedic surgeons should properly understand the concept of intelligent orthopaedics, and identify that data-driven and medical-industrial crossover is the development path of intelligent orthopaedics. They should accurately grasp the connotation of intelligent orthopaedics and persist in the  the technological innovation of intelligent orthopaedics driven by clinical need. Orthopaedic surgeons should closely collaborate integrate with engineers and technicians, insist on exploring in the cross-cutting field, rationally rather than blindly applying cutting-edge engineering technologies, and strive to continuously develop innovative technologies and solutions for intelligent orthopaedics, which will greatly advance the  accurate orthopaedic treatment.

Clinical application of robot-assisted and retrograde elastic intramedullary nail in the minimally invasive treatment of displaced midshaft clavicle fractures

Zhang Yufu, Tan Jie, Zhang Xigong, Han Xiao , Li Yanchao, Gong Maoqi, Huang Qiang , Jiang Xieyuan

2024, 45(5):  744-752.  doi:10.3969/j.issn.1006-7795.2024.05.002

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Objective  To evaluate the clinical efficacy of robot-assisted retrograde intramedullary nail in the treatment of  midshaft clavicle  fractures. Methods  All patients who were diagnosed with displaced midclavicular fractures at Beijing Jishuitan Hospital, Capital Medical University from December 1, 2022 to May 31, 2023 and met the inclusion and exclusion criteria were included in this prospective study. All procedures were navigated and planned by an experienced surgeon using the new TIANJI robotic system for optimal retrograde intramedullary nail entry points and trajectories. The demographics and intraoperative parameters of the patients were recorded. Clinical follow-up was performed at 2 week, 4 week, 6 week, 8 week, 12 week, 6 month and 12 month, respectively. Fracture healing time was assessed by an orthopedic surgeon and a rehabilitation therapist with the Constant Murley Shoulder (CM) score, quick Disabilities of the Arm, Shoulder and Hand (q-DASH) score for the arm, shoulder, and hand, the Scar Cosmesis Assessment and Rating (Scar) Scale, and the Visual Analogue Scale (VAS). Results  A total of 60 patients ［48 males and 12 females, aged （32.97±11.26） years］ were included. Injury causes: 18 cases fell while walking, 32 cases fell while riding electric or motorcycle, 4 cases were injured by car, and 6 cases were injured in sports. According to AO classification, there were 16 cases of type A, 26 cases of type B and 18 cases of type C. The operation time was （53.47±21.63） min, with closed reduction in 50 cases and local limited open reduction in 10 cases. All patients were followed up for (60.50±6.69)week. The fracture healing time was （7.43±2.19）week. Compared with the healthy side, the clavicle shortening rate was significantly improved from (6.44±5.00)% before surgery to (2.09±2.95)% after surgery (P<0.01). The recovery range time of shoulder activity was (9.13±2.20) week, and the recovery exercise time was （12.73±2.39）week. All patients were satisfied with the Scar, and the Scar score was 9.80±0.48. CM scores at 2 week, 6 week and 6 month were 53.67±9.52, 83.22±6.28 and 97.85±2.60, respectively. q-DASH scores at 2 week, 6 week, and 6 month were 33.17±5.37, 17.07±5.37, and 11.42±0.69, respectively. Skin pain caused by nail protrusion occurred in 5 cases (8.33%), and transient nerve plexus irritation occurred in 1 case (1.67%), which disappeared 28 week after operation. Conclusion  Robot-assisted retrograde elastic intramedullary nail is a safe and minimally invasive surgery for the treatment of displaced midshaft clavicle fractures, with the advantages of fast healing, good aesthetics, good functional prognosis and few complications.

ntelligent robot-assisted reduction system for closed reduction of femoral shaft fractures: a cadaveric study

Xiao Honghu, Zhao Chunpeng, Bei Mingjian, Li Bo, Zhu Gang, Wang Yu, Song Yingchun, Wu Xinbao

2024, 45(5):  753-762.  doi:10.3969/j.issn.1006-7795.2024.05.003

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Objective  To explore the efficacy of a self-designed intelligent robot-assisted reduction system in the closed reduction of femoral shaft fracture by a cadaveric study. Methods  Four fresh frozen cadavers (2 male and 2 female ones) were used in this study, and 8 femoral shaft fractures were created in accordance with clinical cases (AO classification, 1 case of type A1, 3 cases of type A2, 2 cases of type A3 and 2 cases of type B2). A self-designed intelligent robot-assisted reduction system was used to assist the closed reduction in the cadaveric models. Intraoperative registration time, autonomous reduction time and total operation time were recorded. The length and femoral neck anteversion before osteotomy and after reduction were measured, and the three-dimensional model of the femur before operation and after reduction was matched using Geomagic Qualify 2013 software, and the reduction error was measured to evaluate the fracture reduction accuracy and quality. Results  Effective reduction was accomplished in 8 bone models with assistance of the self-designed intelligent robot-assisted reduction system. The average intraoperative registration time was （33.3±3.7）min, the autonomous reduction time was (34.8±3.3) min, and the average total operative time was (68.0±4.1) min. The difference in length before osteotomy and after reduction was (1.6±1.6) mm, and the difference in femoral neck anteversion was (4.1±3.5)°. The mean reduction error was (4.3±2.2) mm. Conclusions  Our self-designed intelligent robot-assisted reduction system can assist in completing the closed reduction of femoral shaft fracture, with high reduction accuracy and operational feasibility, reducing the reduction time, avoiding the damage of blood supply around the fracture site, and reducing the exposure to radiation during the operation, it provides a better method for the closed reduction of femoral shaft fracture.

Clinical efficacy of intelligent pelvic fracture reduction robot combined with TiRobot in treating unstable pelvic fractures

Dai Yonghong, Zeng Yanhui, Wu Zhengjie, Zhao Chunpeng, Wang Junqiang, Wu Xinbao

2024, 45(5):  763-772.  doi:10.3969/j.issn.1006-7795.2024.05.004

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Objective  To discuss the early efficacy of Rossum Robot combined with TiRobot in the treatment of unstable pelvic fractures, thereby analyzing its clinical advantages and limitations. Methods  A retrospective evaluation of 19 patients with unstable pelvic fractures treated with Rossum Robot combined with TiRobot at the Department of Orthopedic Trauma,  Foshan Hospital of Traditional Chinese Medicine between May 2022 and November 2023 was conducted. The cohort included 10 males and 9 females according to the Tile classification, there were 14 type C and 5 type B fractures.The median interval from injury to surgery was 12(6-34)d. Minimally invasive closed reduction and internal fixation of pelvic fracture was completed with the joint intervention of the Rossum Robot and TiRobot. Pelvic computed tomography (CT) scans and anteroposterior, outlet, and inlet X-rays were taken before and after surgery. The maximum residual displacement of pelvic rings after reduction were measured according to X-ray and CT images, and the quality of fracture reduction was evaluated by Matta criteria.The fluoroscopy frequency, fluoroscopy time, surgery time, intraoperative blood loss, number of intraoperative guide pin adjustments, quantity and quality of inserted screws, and maximum residual displacement of pelvic rings after reduction were documented.The screw positions were graded according to the postoperative three-dimensional CT reconstruction images.The postoperative monitoring period, fracture healing time and postoperative complications incidence  were recorded, and the Majeed scoring system was used for functional evaluation. Results  With the joint intervention of the Rossum Robot and TiRobot, all 19 patients successfully completed minimally invasive closed reduction and internal fixation of pelvic fractures.The median intraoperative fluoroscopy frequency was 28 （10-120)times. The median fluoroscopy time was 25.2 (6.0-72.6)s. The median surgery time was 206 (125-231)min.The median intraoperative blood loss was 100(50-400)mL. During the surgery, the guide pin adjustment was performed a total of 4 times among 19 patients, with an average of 0.21 adjustments per patient.A total of 67 screws were inserted, with 65 screws being of excellent quality, 0 screws  good quality, and 2 screws poor quality. The overall excellent and good rate for the screws' placement quality was 97.01%.The maximum residual displacement after reduction of pelvic ring was (6.59±3.68) (1.21-13.00)mm.According to Matta criteria, the reduction quality of the pelvic ring was excellent in 7 cases, good in 9 cases, and fair in 3 cases, with a good-to-excellent rate of 84.21%.Follow-up for the 18 cases lasted for 17 months (6-21)months, with the Majeed functional score averaging （86.00±6.65） (74.00-98.00)points and a good-to-excellent rate of 100%, with 8 cases scored excellent, and 10 good. Conclusions   In our study, the Rossum Robot combined with TiRobot can complete intelligent, safe, accurate, minimally invasive, and homogeneous closed reduction and internal fixation for most patients with unstable pelvic fractures, and it can achieve good early efficacy.

Analytical medial unicondylar knee arthroplasty: surgical procedure and early clinical practice 

Deng Wang, Yang Dejin, Zhao Yongqiang, Lu Jiahao, Shi Hongwei, Tang Hao, Wang Zhaolun, Zhang Yunfeng, Shao Hongyi, Zhou Yixin

2024, 45(5):  773-782.  doi:10.3969/j.issn.1006-7795.2024.05.005

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Objective  To report the surgical procedure, early radiographic outcomes and real-time change of joint space balance in analytical medial unicompartmental knee arthroplasty (UKA), and to explore the utilization of analytical UKA in surgical planning and implant design. Methods  This study included the robotic analytical UKA performed in our institute between May 2022 and April 2024. The procedures of analytical UKA were reported in detail. The percentage of patients who reached the dynamic joint space balance were calculated, and the curves of dynamic joint space balance were classified according to their patterns. Preoperative and postoperative hip-knee-ankle (HKA) angle, posterior condylar offset ratio (PCOR) and posterior tibial slope (PTS) were compared. Results  Eighteen analytical medial UKA cases were included and 9 UKAs (50.0%) reached the dynamic joint space balance. The main types of these curves were U type (44.4%), inverted U type (33.3%)  and  horizontal type (11.1%). The knee balance solver was used in 13 cases. The curves of the knee balance solver system indicated that before the femoral cutting the gaps at flexion 10°-50°were larger than those at flexion 70°-120° in all cases. After the trial implantation, the knee balance solver curve in four cases (30.8%) changed into linear type while seven cases (53.8%) showed that after 70° the gaps would increase when the knees were at a higher knee flexion angle. Postoperative HKA were improved when compared with preoperative HKA (178.67°±3.09° vs 173.00°±2.88°; P<0.001). There was no significant difference between the preoperative and postoperative PCOR (0.51±0.05 vs 0.52±0.03, P=0.518),  while the mean postoperative PTS were significantly smaller than the mean preoperative PTS (7.75°±3.28° vs 10.66°±3.03°, P=0.001). Conclusions   Analytical medial unicompartmental knee arthroplasty can guide the surgical planning through the real-time quantitative analysis of multiple parameters. The postoperative radiographic parameters are satisfactory. Some patients can achieve dynamic gap balance during the whole process of flexion and extension.

Curative effect of robot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures

Yang Guang, Zuo Nan, Qi Baochang, Tan Lei, Zhu Dong, Sun Dahui

2024, 45(5):  783-787.  doi:10.3969/j.issn.1006-7795.2024.05.006

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Objective  To evaluate the efficacy of robot-assisted versus free-hand screw placement in the treatment of femoral neck fractures. Methods  A retrospective analysis was conducted on 40 patients with femoral neck fractures treated at the First Hospital of Jilin University from January 2018 to June 2023. Based on the surgical methods, the patients were divided into two groups: the robot group (21 cases) and the free-hand group (19 cases). Intraoperative and postoperative indicators were compared between the two groups. Results  The robot group showed superiority over the free-hand group in terms of operation time, number of intraoperative fluoroscopies, number of intraoperative guide pin adjustments, and Harris scores at 1 year postoperatively (P < 0.05). There was no statistically significant difference between the two groups in terms of fracture healing time (P > 0.05). Conclusions  The TiRobot assists in the treatment of femoral neck fractures with significant advantages such as precision, efficiency, and intelligence. Robot-assisted surgery can shorten the operation time and reduce the possibility of surgery-related secondary injuries, making it worthy of further promotion and application.


Clinical tracking accuracy of non-invasive tracking device in static and dynamic environments

Fan Mingxing, Fang Yanming, He Rui, Zhang Qi, Duan Xingguang, He Da

2024, 45(5):  788-794.  doi:10.3969/j.issn.1006-7795.2024.05.007

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Objective  ObjectiveTo explore the accuracy performance of the newly designed non-invasive tracking system in static and dynamic environments.Methods  The system consists of a non-invasive tracking device and an optical navigation device. In a static environment, the spinal model was scanned by intraoperative C-arm computed tomography (CT), and the marker points in the CT image space were selected for real-time automatic registration. The registration accuracy of the non-invasive tracking device and the registration accuracy of 8 body surface verification points were measured. The non-invasive tracking device was compared with the rigid tracking device connected to the vertebral body, and the position error of the vertebral bone surface point at 3-4 cm below the body surface and the position error of the vertebral internal point at 8-9 cm below the body surface were measured, as well as the angular error between the overall planned path of the guide needle and the actual path. In the previous study, we constructed a spinal vertebral motion model under respiratory motion to simulate the dynamic environment of the vertebral body during surgery. The dynamic environment simulates intraoperative breathing motion through robotic arm servo motion, and the dynamic environment accuracy measurement method was the same as that of the static environment.Results  The non-invasive tracking device registration error was small, （0.483±0.242） mm in static conditions and （0.524±0.229） mm in dynamic conditions. The  registration error of the internal area of the non-invasive tracking device was lower than that of the external area of the non-invasive tracking device, ［（0.472±0.202) mm vs (0.954±0.279) mm，P <0.001］ in static conditions and ［（0.516±0.188） mm vs （1.029±0.252） mm，P<0.001］ in dynamic conditions. The accuracy of the bone surface points and the bone internal points of the 8 guide needle approaches was related to the distance of the non-invasive tracking device. The  position error at 3-4 cm below the body surface was smaller than that at 8-9 cm, ［（0.018±0.024）mm vs （0.061±0.061） mm, P=0.002］ in static conditions and ［（0.403±0.275） mm vs (0.938±0.640）　mm，P<0.001］ in dynamic conditions. The  angle error of the needle approach is small, <0.25° in static environment and <1.50° in dynamic environment.Conclusions  In a static environment, the non-invasive tracking device maintains high position accuracy and angular accuracy for both the surface and deep areas of the body. In a dynamic environment, the positioning accuracy and angular accuracy of the surface and deep areas of the body are reduced, but are still within an acceptable range.

A retrospective cohort study of robot-assisted and navigation-assisted treatment of osteoid osteoma

Xu Hairong, Li Yuan, Shan Huachao, Xu Qiming, Ma Ke, Yu Feng, Niu Xiaohui

2024, 45(5):  795-800.  doi:10.3969/j.issn.1006-7795.2024.05.008

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Objective  This study aims to compare the safety and efficacy of robot-assisted and navigation-assisted techniques in the treatment of osteoid osteoma. A retrospective cohort study was conducted to analyze differences in surgical time, blood loss, success rate, postoperative complications, and patient recovery between the two techniques. Methods  A total of 64 patients with osteoid osteoma who underwent either robot-assisted (n=25) or navigation-assisted (n=39) surgery at Beijing Jishuitan Hospital from August 2022 to December 2023 were included. Data on patient age, gender, lesion location, preoperative lesion size, blood loss, surgical time, follow-up duration, preoperative and discharge Visual Analogue Score (VAS), and success rates were collected and analyzed using descriptive statistics and comparative analysis.  Results  There were no statistically significant differences between the two groups in terms of age, gender, lesion location, preoperative lesion size, preoperative VAS score, and follow-up duration. The robot-assisted group had a significantly shorter surgical time than the navigation-assisted group ［(102.64±21.65） min vs （120.46±30.98）　min, P=0.025］. The amount of blood loss in the robot-assisted and navigation-assisted groups was ［50 (20,50) ml] vs ［50(20,100)ml］, respectively, though this difference was not statistically significant (P=0.287). There were no significant differences in VAS score changes before discharge between the two groups (P > 0.05).  Conclusions   Robot-assisted surgery demonstrates significant advantages in the treatment of osteoid osteoma, particularly in terms of reduced surgical time and increased precision. Future studies should further explore the long-term outcomes and cost-effectiveness of these two techniques to provide more comprehensive guidance for clinical practice.

A noval surgical treatment for large uncontained osteochondral lesion of talus：customized 3D printed cobalt-chromy-molybdenum partial talus

Li Heng, Lai Liangpeng, Sun Ning, Du Hui, Wu Yong

2024, 45(5):  801-807.  doi:10.3969/j.issn.1006-7795.2024.05.009

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Objective  To evaluate its surgical effect and surgical safety of customized 3D printing cobalt-chromy-molybdenum partial talus for large uncontained osteochondral lesions of talus(OLT). Methods  From October 2021 to April 2023, patients with large uncontained talus osteochondral lesions underwent 3D customized partial talus replacement in our center were enrolled.  The 3D modeling software helped to design customized plan and prostheses prototype. Regular follow-up visits were conducted at 3 month, 6 months and 1 year after surgery. Ankle function and pain were assessed again, and postoperative X-rays, implant position, and presence of periprosthetic radiolucency lines were assessed. Results  The average lesion surface area of 12 patients was (252.5±91.1) mm² and the volume was (1 571.5±99.0) mm³. The mean follow-up time was (21.7±5.6) months. The overall satisfaction rate is 91.7%. American Orthopedic Foot and Ankle Society（AOFAS) score (hindfoot) increased from (69.42±10.36)to(89.83±6.89).Foot Function Index(FFI） score decreased from (55.00±31.86)to（14.08±7.95）. The average pain Visual Analog Scale(VAS) score decreased from （3.75±2.14)to(1.17±1.19), with statistically significant differences. There were no major complications such as infection, poor wound healing, and non-union of fractures. Conclusion  For large uncontained OLT, the 3D customized printing prosthesis treatment showed high satisfaction with surgical results, improved significantly the patient function, and relieve the pain. No major complications were observed during an average follow-up of 21 months. It provides a novel clinical solution for the treatment of such OLTs.

A retrospective cohort study on comparison between a novel visualized orthopedic robot-assisted technique versus a free-hand technique of pedicle screw placement in the lumbar spine

Zeng Cheng, Wu Jiayuan, Ding Hongtao, Zhang Ning, Lang Zhao, He Da

2024, 45(5):  808-814.  doi:10.3969/j.issn.1006-7795.2024.05.010

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Objective  To study a novel orthopedic robotic system integrated with visualized tool packages and to compare the screw accuracy and clinical outcomes of the visualization robotic system with those of the traditional free-hand lumbar pedicle screw fixation. Methods  A total of 43 cases with visualized robot-assisted single-segment lumbar spinal canal decompression with fusion were retrospectively analyzed, matched with 85 cases with traditional free-hand pedicle screw placement as the control group. The accuracy of pedicle screws was evaluated on postoperative lumbar computed tomography (CT) images. The two groups were compared in terms of the number of pedicle track adjustments, the number of pedicle screw turnback, the Visual Analogue Scale (VAS), the Japanese Orthopaedic Association (JOA) scores, the operative time, the amount of blood loss, the postoperative hospitalization time, and the postoperative complications.  Results  The accuracy of screw placement in the robotic group was significantly higher than that in the control group (P<0.05),  the number of pedicle track adjustments and screw turnback were significantly lower than that in the control group (P<0.05), and the operation time was significantly longer than that in the control group (P<0.05), while  the other perioperative parameters were not significantly different from those in the control group (P>0.05). Conclusions   The accuracy of pedicle screw placement assisted by the novel visualized robotic system was significantly better than that of free-hand screw placement, and it could reduce the number of repeated adjustments of the pedicle track and screw turnback. Although its operation time is longer than that of traditional surgery, its clinical efficacy is not inferior to that of traditional surgery, and it has more advantages and potentials.

Design of automatically generated patient-specific instrument guides for congenital radioulnar synostosis

Liu Lu, Cui Ying, Zhou Tianfeng, Chen Shanlin

2024, 45(5):  815-822.  doi:10.3969/j.issn.1006-7795.2024.05.011

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Objective  To establish automated bony structure modeling, osteotomy planning, and patient-specific instrument guides design for the precise osteotomy for congenital radioulnar synostosis (CRUS). Methods  The computed tomography (CT) scan of bilateral forearms was performed on 17 patients with unilateral affected forearm. Bony structure modeling was performed using feature point recognition algorithms, and computer-aided design. The patient-specific osteotomy and osteosynthesis guides were designed based on the osteotomy plan, and the simulated surgery operation was performed on the resin model made using 3D printing and according to the digital model. Results  Patient specific instrument guides can be used to perform CRUS osteotomy surgery, and the results of the resin model surgery are consistent with the expected outcome. The interval between the osteotomy guide plate and the bone, the thickness of the osteotomy guide plate, the thickness of the osteosynthesis guide plate handle and the width of osteotomy groove are 3, 4, 9, 0.8 mm respectively. Such osteotomy/osteosynthesis guide plate can perform better and more accurately the corresponding operation. Conclusions  The patient specific instrument guides automatically generated by the assist of digital technology can help surgeon to complete the osteotomy of CRUS.

Impact of repeated intravenous calcium administration on vascular calcification in chronic kidney disease rats

Guan Yiming, Diao Zongli, Huang Hongdong, Liu Wenhu

2024, 45(5):  823-830.  doi:10.3969/j.issn.1006-7795.2024.05.012

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Objective  To investigate the  impact of repeated intravenous calcium stimulation on aortic calcification in adenine diet-induced chronic kidney disease (CKD) rats.  Methods  Thirty-two Sprague-Dawley (SD) rats were randomly divided into control and model groups. Baseline serum creatinine, blood urea nitrogen, calcium, and phosphorus levels were measured. The rats were fed either a normal diet or a 0.75% adenine diet for 6 weeks, followed by a standard diet for all. Both control and model groups were further divided into two subgroups, resulting in four groups: control + calcium chloride (Cont+CaCl₂), control + saline (Cont+NaCl), CKD + calcium chloride (CKD+CaCl₂), and CKD + saline (CKD+NaCl), with 8 rats in each group. Tail vein injections of calcium chloride solution (100 mg/kg) or an equal volume of saline were administered every other day for 8 weeks. After the intervention, the rats were sacrificed to measure serum creatinine, blood urea nitrogen, calcium, and phosphorus levels. Aortic calcium content was assessed, and Von Kossa staining was performed to detect calcification. Immunohistochemical staining was employed to observe the distribution and expression of osteogenic differentiation markers, including the transcription factor runt-related transcription factor 2 （Runx2）. Western blotting analysis was used to detect the protein expression of bone morphogenetic protein 2 (BMP-2).   Results  At baseline, there were no statistically significant differences in body weight or biochemical indicators among the groups (P>0.05). At the end of the 14th week, compared to the control group, the model group showed significantly higher serum creatinine and blood urea nitrogen levels, lower serum calcium levels, and higher serum phosphorus levels (P<0.05). There were no statistically significant differences in serum calcium, phosphorus levels, or aortic calcium content between the CKD+CaCl₂ and CKD+NaCl groups (P>0.05). Von Kossa staining revealed no calcification in the aortas of either group. Compared to the control group, the model group showed increased expression of Runx2 and BMP-2 in the aorta. There were no significant differences in the expression of Runx2 and BMP-2 between the CKD+CaCl₂ and CKD+NaCl groups.  Conclusions  Under the conditions of this study, repeated intravenous calcium stimulation did not induce aortic calcification in adenine diet-induced CKD rats and had no significant impact on aortic osteogenic differentiation.

Consistency evaluation of urine PCR and 24-h urine protein quantification in urine protein evaluation of glomerular disease patients

Chen Xianghui , Jia Ting , Yang Ying , Li Yan , Wei Shizhuo , Wang Jiaqi , Feng Yingying , Ma Fangxia, Chen Zhao, Wang Li , Fu Rongguo ,

2024, 45(5):  831-837.  doi:10.3969/j.issn.1006-7795.2024.05.013

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Objective  To evaluate the consistency between urine protein/creatinine ratio (PCR) and 24-h urine total protein (24-h UTP) in measuring proteinuria levels in patients with glomerular diseases. Methods  Patients with acute and chronic glomerulonephritis, nephrotic syndrome, and other glomerular diseases admitted to the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to July 2024 were selected as the research subjects. Clinical data such as age, gender, primary disease, urine output, blood routine, liver and kidney function, and blood lipids were collected. The results of morning urine PCR and 24-h UTP were also recorded. Multiple linear regression was applied to select indicators that significantly affect PCR and 24-h UTP. Patients were grouped based on these indicators, and Bland-Altman analysis and intraclass correlation efficient（ICC）were applied to evaluate the consistency of the two measurement indicators in each group.  Results  A total of 220 patients were included in this study, including 129 males and 91 females, with an average age of （53.21±17.68） years old. The Spearman correlation coefficient between 24-h UTP and PCR was 0.83 (P ＜0.001). Multiple linear regression showed that urine volume and serum albumin（ALB） levels could affect the results of 24-h UTP, while PCR results were not affected by urine volume but were influenced by estimated glomerular filtration rate（eGFR） and ALB levels. Bland Altman analysis suggests that for patients with urine output of 1 500-2 500 mL, eGFR between 30-89 mL·(min·1.73 m2)^－1, or ALB levels ≥ 30g/L, the two indicators have good consistency in detecting urinary protein levels. ICC further quantified the consistency of two indicators in each group, suggesting that ALB levels and urine volume may be factors affecting the consistency of the two indicators. Conclusions  Although there is a significant correlation between urinary PCR and 24-h UTP results, their consistency and mutual substitutability require comprehensive judgment based on the patients urine volume, ALB, and eGFR levels.

Analysis of clinicopathological characteristics and prognosis of malignant hypertensive nephrosclerosis

Qin Yunlong, Zhou Jin, Liu Meng, Luo Kaifa, Wang Anjing, Wang Di, Zhao Jin, Sun Shiren

2024, 45(5):  838-845.  doi:10.3969/j.issn.1006-7795.2024.05.014

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Objective  To explore the clinicopathological and prognostic characteristics of patients with primary malignant hypertensive nephrosclerosis (MHTN) and identify the key factors influencing the prognosis of MHTN patients. Methods  The pathological and clinical data of hypertensive nephropathy patients diagnosed by renal biopsy in Xijing Hospital of Air Force Medical University from December 2012 to June 2023, were collected. Patients were distinguished into MHTN and benign arteriolosclerosis nephrosclerosis (BAN) groups based on pathological results. Univariate and multivariate Cox regression analyses were performed to identify the risk factors affecting renal prognosis in MHTN patients. Kaplan-Meier survival curves were used to calculate renal cumulative survival rates. The study endpoint was defined as a composite endpoint of end-stage renal disease or death. Results  A total of 231 patients with primary hypertensive nephropathy were included in the study, of which 75 were MHTN patients. The median follow-up time was 20.8 (13.2, 47.1) months, and 36 (52.0%) patients reached the renal composite endpoint. Compared with BAN patients, MHTN patients had more severe clinical manifestations, worse prognosis, and younger average age. Univariate Cox analysis showed that estimated glomerular filtration rate (eGFR), urinary microalbumin creatinine ratio, urinary N-acetyl-β-D-glucosaminidase, plasma albumin, serum calcium, cystatin C (Cys-C), hemoglobin (Hb), fibrinogen (FIB), and total renal chronic pathological score (TRCS) were associated with an increased risk of renal composite endpoints in MHTN patients. Multivariate Cox regression after adjusting for pathological scores revealed that Cys-C (HR=1.490, 95% CI: 1.144-1.942, P=0.003), Hb (HR=0.981, 95% CI: 0.963-0.999, P=0.042), FIB (HR=1.650, 95% CI: 1.125-2.419, P=0.010), and TRCS (HR=1.317, 95% CI: 1.057-1.640, P=0.014) were independent risk factors for renal prognosis in MHTN patients. Conclusions  In MHTN patients, elevated Cys-C and FIB levels, decreased Hb, and severe pathological changes predict adverse renal outcomes. Further increasing the rate of renal biopsy in MHTN patients during clinical diagnosis and treatment can help assess their prognosis.

Correlation between serum β2-microglobulin level and renal anemia in patients on maintenance hemodialysis

Zhang Zongwei, Ding Guohua, Shi Ming

2024, 45(5):  846-852.  doi:10.3969/j.issn.1006-7795.2024.05.015

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Objective  To investigate the correlation between renal anemia and serum β2-microglobulin (β2-MG) levels in maintenance hemodialysis (MHD) patients, and to provide a new viewpoint and basis for the clinical diagnosis and treatment of renal anemia. Methods  MHD patients diagnosed with end-stage renal disease and in stable condition at the Renmin Hospital of Wuhan University from December 2021 to December 2023 were selected for the study, and were divided into the anemia group and the control group according to their hemoglobin levels, and the relevant clinical data and laboratory examination data of the patients were collected. The data were analyzed statistically via SPSS 22.0 software. Results  Compared with the control group, serum β2-MG was significantly higher in the anemia group, and the patients' hemoglobin was positively correlated with leukocytes, total protein, and albumin (P＜0.05), and negatively correlated with high sensitivity C-reactive protein (hs-CRP) and β2-MG (P＜0.05); multifactorial Logistic regression showed that low blood albumin and high level of β2-MG were the independent risk factors for the development of anemia in MHD patients. Conclusions  Elevated serum β2-MG levels in MHD patients were associated with decreased hemoglobin, and low blood albumin and high serum β2-MG were risk factors for renal anemia in patients. Therefore, when treating renal anemia in MHD patients, special attention needs to be paid to the patients' nutritional status and the clearance of large molecule inflammatory toxins such as β2-MG; correcting malnutrition and via β2-MG adsorbent columns first, if necessary, may be more favorable for correcting renal anemia, thus further reducing the incidence of cardiovascular complications and improving the prognosis of MHD patients.

Postsurgical urodynamic study of nerve-sparing radical hysterectomy  in the treatment of cervical cancer

Jin Qiong, Dong Dexin, Zhao Yue, Geng Yuning

2024, 45(5):  853-857.  doi:10.3969/j.issn.1006-7795.2024.05.016

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Objective  To compare bladder function between nerve-sparing radical hysterectomy (NSRH) and radical hysterectomy (RH) for patients with uterine cervical cancer. Methods  This prospective study enrolled 55 patients with cervical cancer between May 2019 and May 2022 at the Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University: with 28 in the NSRH group and 27 in the AH group. Information of patients with stages ⅠB to ⅡA cervical cancer were collected according to the inclusion criteria. Demographic, surgical, and oncological data were collected. Results  The average age in the NSRH group was(51.0±7.9) years, and (46.3±8.5) years in the RH group, with significant statistical difference (P<0.05). There was no significant difference between the two groups in operation duration, blood loss, vaginal length, lymph node metastasis(P>0.05), depth of stromal invasion, or lymphovascular invasion in the postoperative pathology(P>0.05). Residual urine in NSRH group was more than that in RH group(P<0.05). However, the time to postoperative catheter removal was significantly shorter in NSRH group(P<0.05).Conclusions  NSRH can effectively promote the postoperative bladder function of patients with cervical cancer, thereby shortening the recovery time after surgery.

Disposable flexible ureteroscopy for the treatment of ipsilateral parapelvic cyst with secondary renal calculi

Yan Wei, Xiang Peng, Xie Yingwei, Zheng Yupeng, Ping Hao

2024, 45(5):  858-863.  doi:10.3969/j.issn.1006-7795.2024.05.017

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Objective  To assess the clinical effect of holmium laser lithotripsy combined with intrarenal renal cyst incision and drainage in the treatment of parapelvic renal cysts combined with ipsilateral secondary kidney stones by disposable ureteroscope. Methods  From September 2019 to February 2023, 58 patients in Beijing Tongren Hospital, Capital Medical University with parapelvic renal cysts combined with ipsilateral secondary kidney stones were treated with holmium laser lithotripsy and intrarenal incision and drainage of renal cysts using disposable ureteroscope. At 1, 2, 6 and 12 months after surgery, the patients were followed up by ultrasound and/or computed tomography (CT) to detect the recurrence of residual stones and renal cysts. Results  The mean age of the patients was (39.3±15.6) years. The average parapelvic cyst size was (5.8±1.9) cm, including 54 Bosniak Class Ⅰ patients and 4 Bosniak class Ⅱ patients. The average size of kidney stones is (13.3±5.5) mm. The mean operation time was (33.4±12.1) min, and the mean length of stay was (2.3±0.7) d. Complications included transient fever (>38  ℃) in 3 patients and significant bleeding in 1 patient. There were no serious complications. The stone-free rates at 1 month and 2 months were 94.1% (53 cases) and 98.3% (57 cases), respectively. During 1 year of follow-up, the recurrence rate of cysts and stones was 6.9% (4 cases) and 5.2% (3 cases) respectively. Conclusions  This study shows that holmium laser lithotripsy combined with intrarenal renal cyst incision and drainage in the treatment of parapelvic renal cysts combined with ipsilateral secondary kidney stones by disposable ureteroscope are safe and effective in the treatment of parapelvic cysts combined with kidney stones, with satisfactory stone removal rate and low recurrence rate of cysts.

Observation of the effect of flexible suction ureteral access sheath in one-stage operation of complex renal calculi

Zhang Quandong, Liu Hui

2024, 45(5):  864-869.  doi:10.3969/j.issn.1006-7795.2024.05.018

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Objective  To observe the clinical effect of flexible suction ureteral access sheath in one-stage operation of complex renal calculi. Methods  A total of 120 patients with complicated renal calculi  who admitted to Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, were randomly divided into two groups, 60 in the observation group and 60 in the control group. The patients in the observation group were treated with the flexible suction ureteral access sheath, the patients in the control group were treated with ordinary ureter sheath. The average operation time, stone-free rate, infection index, bleeding and average hospital stay were compared between the two groups. Results  The average surgical time of the observation group patients was (58.81±15.60) minutes, the stone free rate was 91.67% (55/60), the white blood cell  （WBC） count was (7.43±0.52) × 10⁹/L, the procalcitonin (PCT) was (0.96±0.10) ng/mL, and the inpatient days was 2 (2， 3) days. Compared with the control group, the difference was statistically significant (P<0.001). There was no statistically significant difference in the decline of hemoglobin (HGB) between the two groups (P=0.075). Conclusions Application of  the flexible suction ureteral access sheath in one-stage operation of complex renal calculi can significantly increase the stone-free rate, reduce the average operation time and hospital stay, and reduce the incidence of infection. 

Early diagnosis and treatment of urinary sepsis after ureteroscopic lithotripsy of upper urinary tract stones

Zhang Dakun, Zhang Hongbo, Dong Dexin, Gao Xiang, Zheng Han, Zhang Lang

2024, 45(5):  870-874.  doi:10.3969/j.issn.1006-7795.2024.05.019

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Objective  To investigate the early diagnosis and treatment strategies for urinary sepsis after ureteroscopic lithotripsy for upper urinary tract stones.Methods  A retrospective analysis was conducted on the data of 32 patients with upper urinary tract stones who developed urinary sepsis after ureteroscopic lithotripsy in Beijing Longfu Hospital from January 2019 to August 2023. Using a control principle and a 1∶2 ratio, clinical data of 64 patients who underwent surgery during the same period without urinary sepsis were selected for statistical analysis, and the risk factors and early diagnosis and treatment strategies for urinary sepsis were analyzed.Results  By detecting blood white blood cells and procalcitonin at 2, 6, and 12 hours after surgery as key indicators for early warning, urinary sepsis was diagnosed early. Early treatment was given intravenous meropenem (1.0 once every 8 hours) as anti infective therapy, and fluid resuscitation therapy was performed to maintain the balance of inflow and outflow. All 32 patients with urinary sepsis recovered successfully. Univariate analysis suggests that age (≥ 60 years), surgery time (≥ 120 min), female gender, positive preoperative urine culture, preoperative fever, and stone diameter (≥ 20 mm) are independent risk factors for postoperative urinary sepsis in upper urinary tract stones (P<0.05). Conclusions Post ureteroscopic lithotripsy for upper urinary tract stones is associated with urinary sepsis, which is a clinical emergency and critical condition. Preoperative high-risk factors include age ≥ 60 years, female gender, positive urine culture before surgery, preoperative fever, and stone diameter ≥ 20 mm. Blood white blood cells and procalcitonin at 2, 6, and 12 h after surgery can be key indicators for early warning. Early detection and active anti infection treatment after surgery are key measures for the diagnosis and treatment of urinary sepsis.

Chinese and Western medicine treatment for lower urinary tract dysfunctions in postmenopausal women: a systematic review

Zhao Yue, Zhang Quandong

2024, 45(5):  875-880.  doi:10.3969/j.issn.1006-7795.2024.05.020

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Lower urinary tract dysfunction (LUTD) is a key problem for patients with genitourinary syndrome of menopause (GSM). LUTD is mainly caused by low estrogen levels, urogenital atrophy, urinary tract infections and alterations in the vaginal microbiota. These symptoms adversely affect many aspects of a woman's daily life. LUTD treatment involves traditional Chinese and Western medicine prevention and health monitoring. Vaginal low estrogen in the treatment of LUTD is the mainstay of medical treatment which is a  key comprehensive, individualized and synergistic therapeutic approach to restore urogenital physiology. This review describes the research progress of menopause and Chinese and Western medicine treatment for LUTD.

Investigating the temporal characteristics of motor learning deficits in Thy 1-SNCA early Parkinson's disease model mice

Fu Wenxin, Wang Tie, Yang Runing, Qu Mingqin, Gao Ge, Yang Hui, Ja Jun

2024, 45(5):  881-890.  doi:10.3969/j.issn.1006-7795.2024.05.021

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Objective  In this experiment, a mouse model of early Parkinson's  (PD) disease was established to explore the temporal characteristics of PD motor learning deficits. Methods  Six-month-old Thy 1-SNCA transgenic mice were selected as an early PD model and compared with wild type (WT) mice for analysis. The mice's motor function and spatial working memory ability were assessed by experiments such as open field test, pole test, and Y-maze test, and the typical accelerating rotarod test was used as a behavioral paradigm for motor learning. Results  The six-month-old Thy 1-SNCA transgenic mice did not show abnormalities in motor function and spatial working memory ability, but presented obvious characteristics of motor learning deficits. Conclusions  Specific motor learning deficits exist on early PD model mice, which can be used as a detection indicator of early PD. And the typical accelerating rotarod test can be used as a key behavioral method for detecting motor learning deficits in PD.

Exploratory study on the ameliorative effects of Trichinella spiralis paramyosin on chronic inflammatory bowel disease

Wu Anqi, Luo Zeni, Jiang Yao, Wang Zhikai, Zhu Xinping, Sun Ximeng

2024, 45(5):  891-899.  doi:10.3969/j.issn.1006-7795.2024.05.022

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Objective  This investigation seeks to discern the effect of Trichinella spiralis paramyosin (TsPmy) in modulating chronic colitis. Methods  We commenced with the preparation of TsPmy, followed by the induction of chronic colitis in Rag1 KO mice via naïve T cells. The subjects Rag1 KO mice were systematically allocated into three groups by random number table: a treatment group receiving CD4⁺Foxp3^－CD45RB^hi T cells with TsPmy, a control group receiving CD4⁺Foxp3^－CD45RB^hi T cells with PBS, and a baseline group consisting of untreated Rag1 KO mice. Mice diagnosed with chronic colitis received intraperitoneal TsPmy injections. Subsequent evaluations included assessments of clinical manifestations, colon shortening, and histological examination of colonic inflammation using hematoxylin-eosin (HE) staining. Flow cytometry facilitated the quantitative analysis of T helper 1 cell （Th1） and T helper 17 cell (Th17) cell populations in the colonic lamina propria, alongside the enumeration of gut-specific CD103⁺ regulatory dendritic cells (DCs). Results  Administering TsPmy conferred a significant attenuation of the weight loss, disease activity index, and pathological damage of colon tissue in mice. Key findings included a marked decrement in the proportions of pro-inflammatory Th1 and Th17 cells and an enhanced presence of immunomodulatory CD103⁺DCs within the colonic lamina propria. Conclusions  TsPmy has a mitigating influence on chronic colitis in murine models through the expansion of CD103⁺ DCs and the concurrent reduction of Th1 and Th17 cell populations. These insights pave the way for further investigation into helminth-derived paramyosins as a novel therapeutic strategy for chronic colitis.

Identification and verification study of early-onset and late-onset preeclampsia genetic biomarkers using bioinformatics analysis

Zhao Xuanyu, Jiang Yan, Sui Feng

2024, 45(5):  900-906.  doi:10.3969/j.issn.1006-7795.2024.05.023

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Objective  The aim of this study was to identify characteristic genetic biomarkers that can differentiate between early-onset and late-onset preeclampsia patients and to investigate the differentiating ability of these genes. Methods  Data sets for early-onset and late-onset preeclampsia(GSE74341, GSE190639 and GSE4707 data sets) were obtained from the GEO database. The GSE74341 and GSE190639 data sets were used as the experimental group, and the GSE4707 data set was used as the verification group to screen and verify the differentially expressed genes during early-onset preeclampsia and late-onset preeclampsia. Two machine learning methods, namely  least absolute shrinkage and selection operator （LASSO） and support vector machines-recursive feature elimination （SVM-RFE）, were employed to select characteristic genes. The discriminative ability of these genes was evaluated using receiver operating characteristic (ROC) curves. Results  Compared to early-onset preeclampsia, we identified seven significantly upregulated genes and three significantly downregulated genes in late-onset preeclampsia. By utilizing the two machine learning methods and analyzing gene expression differences in the validation group, one characteristic gene (MME) was selected. The area under the ROC curve (AUC) for the experimental group and validation group was 0.975 (95% CI: 0.921-1.000) and 1 (95% CI:1.000–1.000), respectively. Conclusions  Our findings suggest that MME may serve as a potential characteristic gene for distinguishing between early-onset and late-onset preeclampsia.

Analysis of perioperative blood management in 23 RhD-negative children undergoing neurosurgery

Wang Qi, Liang Hui, Lu Yu, Han Ruquan

2024, 45(5):  907-911.  doi:10.3969/j.issn.1006-7795.2024.05.024

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Objective  Retrospective analysis of perioperative blood management in RhD-negative children undergoing neurosurgery, and analysis of the characteristics of management of such children to improve clinical prognosis and safety.  Methods  We retrospectively collected the medical records of RhD-negative children who underwent intracranial occupancy resection from 2015 to 2022 and analyzed demographic information, laboratory test results, blood preparation and transfusion-related perioperative blood management. Results  Twenty-three RhD-negative children were included in the analysis. The average age of the children was (7±3.5) years old, preoperative preparation of allogeneic blood was requested in 22 cases (95.7%), 17 cases (73.9%) were successful and 5 cases (21.7%) were unsuccessful in preoperative blood preparation, the time between requesting blood preparation and surgery was (5.8±3) d, and 260 (260, 455) mL of allogeneic red blood cells were prepared, of which 1 case (4.3%) had 400 mL of preoperative autologous stored whole blood. Intraoperative bleeding was 4.8 (2.2, 13.3) mL/kg. Of the 10 blood transfusions, 7 (30.4%) were transfused with allogeneic red blood cells only, 1 (4.3%) was transfused with allogeneic red blood cells and autologous red blood cells, 1 (4.3%) was transfused with autologous red blood cells, and 1 case (4.3%) was transfused with 150 mL of stored whole blood. The transfusion rate was 43.5%, with the crossmatch to transfusion (C/T) ratio of 2.7, and transfusion index (Ti) of 1. Intraoperative arterial blood gas analysis was performed in 12 (52.2%) cases, thromboelastography was monitored in 2 (8.7%) cases. Postoperative hemoglobin was （117±19.4） g/L. Mild anemia was observed in 6 (26.1%) cases, and moderate anemia was observed in 2 (8.7%) cases after surgery. Conclusions  It is necessary to formulate a blood transfusion plan and reasonable perioperative blood management according to the type and location of the child's lesion and adopt a multimodal treatment strategy to reduce bleeding and the dependence on allogeneic RhD-negative blood to ensure the safety of the child's surgery.

Research progression of slit guidance ligand 3

Jiang Huan , Li Jiaoqing, Xu Haosen , Lan Jinyi , Yang Shanzhi , Zhang Ting , Liu Peimin , Wu Danfeng , Bai Xiaoyan

2024, 45(5):  917-922.  doi:10.3969/j.issn.1006-7795.2024.05.026

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Slit guidance ligand (Slit) is a family of highly conserved secreted glycoproteins that interact with their roundabout guidance receptor (Robo). At present, three Slit genes (Slit 1-3) and four Robo genes (Robo 1-4) have been identified in mammals.  Studies have shown that Slit3 has a wide range of biological functions, such as cell migration, bone formation, angiogenesis, and tumorigenesis.  At the same time, the mechanisms of Slit3-involved diseases have been investigated, though the pathogenesis of Slit3 is not fully understood.  Through studying the pathogenesis of Slit3, we could better explore the pathogenic targets for disease progression and specific treatment.  This review summarized the research progress of Slit3 in various diseases, and expounded its role and possible mechanism in related diseases.

Ethenic Chinese scientist Chen Zhijian  discovers the cGAS-STING signaling pathway that senses DNA for immune surveillance——the 2024  Lasker Basic Medical Research Awards

Zhou Yan, Wu Wei

2024, 45(5):  923-927.  doi:10.3969/j.issn.1006-7795.2024.05.027

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On September 19, 2024 by Beijing Times, the 2024 Albert Lasker Basic Medical Research Award, an important biomedical award, honors a biochemist, Zhijian“James”Chen (UT Southwestern Medical Center, University of Texas) for the discovery of the cGAS enzyme that senses foreign and self DNA, which solves the mystery of how DNA stimulates immune and inflammatory responses.