Congenital pseudarthrosis of the tibia（CPT） is a rare tibia disease in children's orthopedics, which is prone to bone nonunion, pseudarthrosis, and lower limb deformity, and is difficult to cure. Successful treatment remains challenging for orthopedic surgeons, despite many treatments developed for this disease. In recent years, with the in-depth study of CPT, the invention of new surgical methods such as "4-in-1 fusion" and "Cross-union" of tibia and fibula, and the comprehensive use of new drugs such as bisphosphonates and bone morphogenetic proteins, the cure rate has gradually increased and the rate of refracture has reduced. The present status and progress of treatment of CPT in recent years were summarized in this paper, aiming to provide reference for clinical treatment.

Objective To establish and validate a nomogram model based on multimodal ultrasound radiomics to predict the risk of cardiovascular diseases （CVD） in patients with diabetic kidney disease （DKD）. Methods A retrospective analysis of baseline clinical data and multimodal ultrasound images from 167 DKD patients was conducted. The ultrasound images were segmented and radiomic features were extracted using 3D Slicer software. A radiomics score was generated for each patient using the least absolute shrinkage and selection operator （LASSO） algorithm. Based on these scores and clinical predictors related to CVD, a nomogram model was established to predict the risk of CVD in DKD patients. The model was internally validated using the receiver operating characteristic （ROC） curve, calibration curve, and decision curve analysis （DCA）. Results Utilizing the LASSO algorithm, five radiomic features closely related to the incidence of CVD were extracted from the dual mode elastography of each patient. The radiomics score, which was constructed based on these features, predicted the risk of CVD with an area under ROC curve （AUC） of 0.764. In terms of clinical features, age, body mass index, low-density lipoprotein cholesterol, and glycated hemoglobin were identified as independent risk factors for developing CVD. A radiomics nomogram, built based on these factors and the radiomics score, significantly outperformed the radiomics score alone in predicting the risk of CVD, with an AUC of 0.897. The calibration curve demonstrated a high consistency between the predicted probability of CVD occurrence by the nomogram and the actual incidence. DCA further validated that the nomogram achieved a net clinical benefit at different threshold probabilities. Conclusion The radiomics nomogram established in this study demonstrates excellent performance in predicting the risk of DKD patients developing CVD. It holds promise to aid clinicians in achieving individualized management and early intervention for DKD patients.

Objective To investigate the clinical and pathological characteristics, diagnosis, and differential diagnosis of clear cell papillary renal cell tumour （CCPRCT）, aiming to enhance the understanding of this tumour. Methods Clinical data, histopathological patterns, immunohistochemical and molecular assay results of four patients with CCPRCT were retrospectively analysed, followed up and reviewed in the literature. Results The study included four patients, two males and two females, aged between 39 and 73 years. One of the patients had a history of end-stage renal disease. The masses observed had a maximum diameter ranging from 1 to 3.5 cm, were well-defined, either solid or cystic, and had a color ranging from grayish-white to grayish-yellow and grayish-red. Under the light microscope, the tumour cells were arranged in tubular, papillary, vesicular or cystic shapes with varying proportions. The tumour cells were small and cubic with transparent cytoplasm. The World Health Organization/International Society of Urological Pathology （WHO/ISUP） nuclear grading was 1-2 for the tumour cells, and the characteristic nuclei were neatly arranged at the lumen edge away from the basement membrane. There was no renal sinus invasion, vascular invasion, coagulation necrosis, or other aggressive tumour features. The immunophenotypes of the tumour cells were positive for cytokeratin （CK）7, carbonic anhydrase （CA）Ⅸ, pan-cytokeratin （panCK） AE1/AE3 and vimentin, partially positive for CD10, and negative for P504S, CD117 and TFE3. The fluorescence in situ hybridization did not show any 3p deletion. Follow-up was conducted on three cases for 8-78 months, and none of them experienced tumour recurrence or metastasis. Conclusion CCPRCT is a rare renal tumour with a good clinical prognosis. It is important to differentiate it from common low-grade clear cell renal cell carcinoma and papillary renal cell carcinoma. Accurate diagnosis can improve the quality of patients' survival.

Objective To investigate the value of ultrasonography in the diagnosis of oblique vaginal septum syndrome （OVSS） and postoperative follow-up. Methods The clinical data and ultrasound presentation of eight patients with OVSS were retrospectively analyzed to identify the ultrasound features of OVSS. Results The eight patients with OVSS reported progressive dysmenorrhea （7 cases）, foul-smelling odor of vaginal discharge during menstruation （3 cases）, prolonged menstruation （3 cases）, and lower abdominal pain with anal bulge （3 cases）. Of them, 2 cases （25%） were type Ⅰ, 5 cases （62.5%） were type Ⅱ, and 1 case （12.5%） was type Ⅲ. Seven cases had double uterus and double cervix deformities, and 1 case had complete mediastinum uterus. The location of the diastasis was on the right side of the uterus in 4 cases, and on the left side of the uterus in 4 cases. There were 6 cases of cervicovaginal fluid and 1 case of intrauterine fluid. All of the 8 cases were accompanied by renal agenesis on the side of the diastasis. All cases were confirmed by surgical pathology. No fluid in the uterine cavity, cervical canal, or vagina was found in the postoperative follow-up, and the clinical symptoms were significantly relieved, and one case became pregnant and delivered. Conclusion Ultrasonography is the preferred diagnostic method for OVSS and is valuable in the treatment and postoperative follow-up of this disease.

Objective To analyze the therapeutic effect of right median nerve electrical stimulation combined with early continuous functional exercise on postoperative rehabilitation of hypertensive cerebral hemorrhage patients. Methods Sixty surgical patients with hypertensive cerebral hemorrhage admitted from January 2020 to December 2022 were selected as study subjects, and divided into a control group （30 cases, early continuous functional exercise） and a treatment group （30 cases, right median nerve electrical stimulation combined with early continuous functional exercise）. The therapeutic effects of the two groups were statistically compared. Results After treatment, the National Institutes of Health stroke scale （NIHSS） score and resistive indexes （RI） of anterior/ middle/ posterior cerebral artery in the control group were significantly higher than those in the treatment group （P<0.05）, while the Fugl-Meyer assessment （FMA） score, Barthel index, mean velocity of blood flow （Vm） at anterior/ middle/ posterior cerebral artery, and motor nerve conduction velocity （MNCV） and sensory nerve conduction velocity （SNCV） of median nerve and common peroneal nerve in the control group were significantly lower than those in the treatment group （P<0.05）. Conclusion In the postoperative rehabilitation of hypertensive cerebral hemorrhage patients, the combination of right median nerve electrical stimulation and early continuous functional exercise can quickly restore the nerve function and daily living ability of patients, and promote the prognosis.

Objective To evaluate the impacts of endoscopically assisted anterior lacrimal recess technique versus Caldwell-Luc approach on sinus function and 1-year recurrence rate of patients with inverted papilloma of nasal cavity and paranasal sinuses. Methods A total of 86 patients with inverted papilloma of nasal cavity and paranasal sinuses admitted from January 2019 to August 2022 were randomly divided into an observation group and a control group according to random number method, with 43 cases in each group. The observation group received treatment via the endoscopically assisted approach targeting the anterior lacrimal recess, while the control group was treated with endoscopically assisted Caldwell-Luc approach. The sinus function scores, surgery-related indicators,objective inspection indexes, and 1-year recurrence rate were compared between the two groups. Results Six months post-operation, the observation group showed significant improvements in nasal symptoms, sleep disturbances, emotional well-being, and symptom scores, surpassing those in the control group （P<0.05）. Surgical duration, blood loss during surgery, and lengths of hospital stays were also notably reduced in the observation group compared to the control group （P<0.05）. The scores of objective evaluations of conditions such as polyps, mucosal swelling, and nasal discharge in the observation group were significantly lower than those in the control group （P<0.05）. Furthermore, the rates of complications like nasolacrimal duct damage, channel adhesion, numbness around the wound, and narrowing of the wound were significantly lower in the observation group than in the control group （P<0.05）. Although the 1-year recurrence rate in the observation group was lower than that in the control group, this difference did not reach statistical significance （P>0.05）. Conclusion Endoscopy-assisted anterior lacrimal recess approach for the treatment of inverted papilloma of nasal cavity and paranasal sinuses has more significant advantages in improving sinus function, and reducing operation-related indicators, objective examination indicators and complications than the Caldwell-Luc approach. However, there is no significant difference between the two approaches in terms of recurrence rate one year after surgery.

Objective To explore the application value of endoscopic thyroidectomy through axillary or oral vestibular approaches in the treatment of unilateral papillary thyroid carcinoma with negative cervical lymph nodes （cN0 stage）. Methods A total of 86 patients with cN0 stage unilateral papillary thyroid carcinoma who underwent surgical treatment from January 2020 to June 2023 were randomly divided into a control group and an observation group, with 43 patients in each group. The control group underwent endoscopic thyroidectomy via the oral vestibular approach, while the observation group underwent endoscopic thyroidectomy via the axillary approach. The surgical time, intraoperative blood loss volume, postoperative drainage volume, number of central lymph node dissections, visual analog scale （VAS） score, total incidence of complications, and postoperative satisfaction were observed and compared between the two groups of patients. Results The intraoperative blood loss volume, postoperative drainage volume, and VAS score of the observation group were all lower than those of the control group （P<0.05）, but the number of central lymph node dissection was higher （P<0.05）. There was no statistically significant difference in surgical time and hospitalization time between the two groups of patients （P>0.05）. There was also no statistically significant difference in the total incidence of complications between the observation group （16.27%） and the control group （18.60%） （P>0.05）, but the postoperative satisfaction rate （97.67%） of the observation group was higher than that of the control group （79.07%）, and the difference was statistically significant （P<0.05）. Conclusion Transaxillary endoscopic thyroidectomy can better protect the anterior cervical functional area and reduce postoperative discomfort in the anterior neck. Comparably, transoral vestibular endoscopic thyroidectomy features smaller operating space, higher difficulty, overall longer surgical time, and higher risks of postoperative infection, despite better cosmetic effect. Therefore, transaxillary endoscopic thyroidectomy is more effective in the treatment of cN0 unilateral papillary thyroid carcinoma.

Objective To explore the effects of ultrasound bone knife on surgical indicators, postoperative pain, and complications in the extraction of mandibular low impacted wisdom teeth. Methods A total of 61 patients with mandibular low impacted wisdom teeth on both sides （a total of 122 mandibular low impacted wisdom teeth） admitted from August 2022 to October 2023 were selected for the study. They were randomly divided into a control group of 30 cases and an observation group of 31 cases, using traditional bone chiseling and crown chopping methods for extraction and ultrasonic bone knife methods for extraction, respectively. The inflammatory mediators, oxidative stress mediators, surgical time, intraoperative bleeding volume, postoperative pain [visual analogue scale （VAS） score], and complications were compared between the two groups. Results After surgery, the interleukin （IL）-1β, IL-6 and malondialdehyde （MDA） levels were lower in the observation group than in the control group, while the superoxide dismutase （SOD） and glutathione peroxidase （GPx） were higher （P<0.05）. The observation group had lower surgical time, bleeding volume, VAS scores at 6 and 24 h after surgery, and postoperative complication rate than the control group （P<0.05）. Conclusion The application of ultrasound bone knife in the extraction of mandibular low impacted wisdom teeth can shorten the surgical time of patients, reduce intraoperative bleeding, improve inflammatory mediators and oxidative stress mediators, alleviate postoperative pain, and reduce the incidence of complications, which is worthy of recognition.

Objective To explore the clinical efficacy of phacoemulsification combined with angle separation surgery on patients with cataract and angle closure glaucoma and its impact on complications. Methods A total of 100 patients with cataract combined with angle closure glaucoma admitted between February 2018 and April 2024 were selected and randomly divided into a control group and an observation group, with 50 patients in each group, using a random number table method. The control group patients were treated with cataract phacoemulsification combined with artificial lens implantation, while the observation group patients were treated with cataract phacoemulsification combined with artificial lens implantation and angle separation surgery. Observation indicators included treatment efficacy, incidence of postoperative complications, and improvement in quality of life. Results Compared with the control group, the observation group had a higher total effective rate of treatment （P<0.05）. The incidence of postoperative complications in the observation group was significantly lower than that in the control group （P<0.05）. Before treatment, the quality of life indicators were comparable between the control group and the observation group （P>0.05）. After treatment, both groups showed an increase in the quality of life indicators, and the observation group had higher scores than the control group （P<0.05）. Conclusion The application of phacoemulsification combined with artificial lens implantation and angle separation has a prominent effect in the treatment of cataract and angle closure glaucoma, which can reduce the occurrence of postoperative complications and improve the quality of life of patients. It is worthy of widespread clinical application.

Objective To explore the role of exercise therapy in improving motor function and relieving pain level in patients with knee osteoarthritis. Methods From September 2021 to December 2023, 66 patients with knee osteoarthritis were randomly divided into two groups by random number table method： a control group receiving routine intervention and an observation group receiving exercise therapy, with 33 patients in each group. Motor function, pain level, quality of life, and knee mobility were compared between the two groups. Results After designed intervention, the Lysholm knee scoring scale （LKSS） score in the observation group was higher than that in the control group （P<0.05）. The proportion of painless patients in the observation group was higher than that in the control group, while the proportion of moderate pain paients was lower （P<0.05）. The physical function, psychological activity, social ability, and material life state scores of Generic Quality of Life Inventory in the observation group were higher than those of the control group （P<0.05）. No significant difference was found in flexion gap between the two groups （P>0.05）, but the observation group showed larger extension gap and shorter time for active knee flexion at 90° and 120° than the control group （P<0.05）. Conclusion Exercise therapy can improve motor function, alleviate pain, and enhance quality of life of patients with knee osteoarthritis, and it is worth promoting.

Objective To evaluate the value of different mesh fixation methods in laparoscopic totally extraperitoneal （TEP） herniorrhaphy for inguinal hernia. Methods A total of 100 patients with inguinal hernia treated in Beijing Pinggu District Hospital of Traditional Chinese Medicine from March 2020 to March 2023 were selected and divided into two groups according to different treatment methods： non-fixation group （67 cases, laparoscopic TEP herniorrhaphy with self-fixation mesh） and medical adhesive group （33 cases, laparoscopic TEP herniorrhaphy with traditional mesh）. The clinical data of the two groups were compared and analyzed. Results There was no significant difference between the two groups in operative time and amount of bleeding （P>0.05）. The time of first anal exsufflation, eating after operation, free movement and hospitalization in the non-fixed group were significantly shorter than those in the medical adhesive group （P<0.05）. After treatment, the visual analogue scale （VAS） and short form 36-item health survey （SF-36） scores of both groups were significantly improved （P<0.05）, and the VAS and SF-36 scores at 6 months after operation in the non-fixed group were significantly better than those in the medical adhesive group （P<0.05）. The incidence rate of postoperative complications in the non-fixation group was significantly lower than that in the medical adhesive group （P<0.05）. Conclusion The laparoscopic TEP herniorrhaphy for inguinal hernia with self-fixed mesh can promote the postoperative rehabilitation of patients, and can significantly reduce the postoperative complications, which is worthy of clinical promotion.

Objective To study the feasibility of not using opioids in ureteroscopic holmium laser lithotripsy under general anesthesia with laryngeal mask airway. Methods Patients with elective lithotripsy who were diagnosed and treated in Xuzhou City Hospital of Traditional Chinese Medicine between August 2022 and February 2023 were enrolled as study subjects and randomly divided into an experimental group of 30 cases and a control group of 30 cases. Both groups were given 0.4 μg/（kg·h） dexmedetomidine pump 10 min before anesthesia induction. The experimental group was given 0.3 mg/kg esketamine, and the control group was given fentanyl during anesthesia induction. The experimental group was given 0.1 mg/kg ketamine combined with propofol pump, and the control group was given remifentanil combined with propofol pump during anesthesia maintenance. The mean arterial pressure （MAP） and heart rate （HR） were compared between the two groups at 10 min before anesthesia induction （T0）, at the time of loss of consciousness （T1）, immediately after insertion of laryngeal mask airway （T2）, at the beginning of the surgery （T3）, at the end of the surgery （T4）, and at the time of extraction of laryngeal mask airway （T5）. The dosage of propofol and the use of intraoperative vasoactive drugs were recorded. The recovery time of spontaneous breathing, laryngeal mask airway removal time, postoperative nausea and vomiting, postoperative 30 min visual analogue scale （VAS） score, and the number of cases who required additional nonsteroidal anti-inflammatory drugs （NSAIDs） at postoperative 4 h were also compared between the two groups. Results At T1, the MAP and HR in the experimental group were higher than those in the control group （P<0.05）, and there was no significant difference at other time points （P>0.05）. The dosage of propofol in the experimental group was significantly less than that in the control group during anethesia maintenance （P<0.05）. The cases who used intraoperative vasoactive drugs in the experimental group was less than the cases in the control group, but no statistical difference was found （P>0.05）. There was no statistical difference in the recovery time of spontaneous breathing and laryngeal mask airway removal time between the two groups （P>0.05）. Three patients in the experimental group experienced postoperative nausea and vomiting, and the number was 5 in the control group, with no difference （P>0.05）. The resting VAS score at 30 min after surgery in the experimental group was significantly lower than that in the control group （P<0.05）. Three patients in the experimental group took oral analgesic after surgery, and 5 patients in the control group did, with no difference （P>0.05）. Conclusion Esmketamine combined with dexmedetomidine and NSAIDs makes it possible not to use opioids during ureteroscopic holmium laser lithotripsy under general anesthesia with laryngeal mask airway.

Objective To observe the effect of epidural block combined with general anesthesia on recovery after radical resection of colorectal cancer. Methods A total of 64 patients who underwent radical surgery for colorectal cancer from August 2021 to March 2024 were selected. They were divided into a combination anesthesia group （hereinafter referred to as the combination group） and a control group based on different anesthesia methods,with 32 cases in each group. The control group received general anesthesia for surgery, while the combination group received general anesthesia combined with intrathecal anesthesia. The incidence rate of postoperative complications, first exhaust time, defecation time, and length of hospital stay were compared between the two groups. Results After the surgery, the incidence rate of postoperative complications in the combination group was significantly lower than that in the control group （P<0.05）. The first postoperative exhaust time, defecation time, and length of hospital stay in the combination group were significantly shorter than those in the control group （P<0.05）. The visual analogue scale （VAS） score at 12 h after surgery was significantly lower than that in the control group （P<0.05）. Conclusion Epidural block combined with general anesthesia can significantly reduce the incidence of postoperative complications after radical resection of colorectal cancer, promote postoperative exhaust and defecation, and shorten the length of hospital stay.

Objective To investigate the clinical application value of posterior median anal sphincter partial dissection based on external hemorrhoid dissection combined with copper ion electrochemical therapy in the treatment of mixed hemorrhoids. Methods A total of 80 patients with mixed hemorrhoids treated from March 2020 to August 2023 were selected as study subjects, and divided into a control group and an observation group according to the random number table method, with 40 cases in each group. The control group was treated with external hemorrhoid dissection combined with copper ion electrochemical therapy, while the observation group was treated with posterior median anal sphincter partial dissection on the basis of the control group. The anorectal function before and after surgery and recurrence rate were compared between the two groups. Results Before surgery, there were no significant differences between the two groups in maximum anal systolic pressure and resting anal pressure （P>0.05）. One month after surgery, the observation group showed lower levels of maximum anal systolic pressure and resting anal pressure compared to the control group （P<0.05）. The recurrence rate in the observation group （1 case） was lower than that in the control group （8 cases） （P<0.05）. Conclusion On the basis of external hemorrhoid dissection combined with copper ion electrochemical therapy, the use of posterior median anal sphincter partial dissection can effectively improve anal function and reduce the risk of recurrence in patients with mixed hemorrhoids.

As one of the best treatments for end-stage renal disease, kidney transplantation has been widely carried out worldwide. However, due to the problems of immune rejection and postoperative complications in kidney transplantation, how to improve the success rate of kidney transplantation and prolong the life of transplanted kidney is still a major problem. Exosomes participate in the whole process of kidney transplantation, including preoperative diagnosis, postoperative immune rejection and other complications, because of their information transmission and material transport functions. This article expounded the important roles of exosomes in kidney transplantation from three aspects of immune rejection, immunosuppressant toxicity, and other post transplant complications, in order to provide new ideas for clinical diagnosis and treatment.

After the introduction of the working principle of digital subtraction angiography （DSA） bulb tube, through the analysis of three typical faults of DSA bulb tube, the main causes of the faults were found, and the common fault types of DSA bulb tube were summarized. It was concluded that when installing a new bulb tube, it was necessary to check the wiring of the oil pump carefully, and carry out the necessary training and preheating of the bulb tube to ensure its stable operation. Finally the maintenance and acceptance procedures and standards of the various parts of DSA bulb tube were described in detail.

Objective To design a wireless low-energy nocturnal erectile signal sensor which can replace the wired transmission sensor and reduce the size of the wearable device, aming to improve the wearable experience of clinical users. Methods The consistency of wearing comfort and monitoring initial value was improved by setting the sensor wearing identifier and wearing detection program. A multi-functional sensor was composed of a flexible tension sensor and a flexible pressure sensor to collect the data of penis change. A bluetooth module was used to transmit the data to the personal computer （PC）, then quintic polynomial curve fitting was performed by the method of least squares using the software on the host PC, and finally according to the capacitance-time and pressure-time relationships, a nocturnal erection curve was obtained. Results Through the simulation experiment, the sensor signal was successfully transmitted to the PC, and the software displayed the change of pressure and circumference in real time. Conclusion This study has realized erectile monitoring wirelessly, and separated the information acquisition module and the information processing module, which further facilitates the application of nocturnal penile tumescence test （NPT） technology in perioperative surgery.

Objective To explore the effect of family-integrated care on the growth and development of premature infants in neonatal transition ward, provide clininal reference for standardizing family-integrated care, improve the quality of care of premature infants after discharge, promote their growth and development, and reduce their readmission rate. Methods From January to October 2022, 42 premature infants and their mothers who were born and admitted to the neonatal transition unit at the General Hospital of Ningxia Medical University were selected as study subjects, and were divided into a control group （20 cases）and an intervention group （22 cases） according to random number table method. The control group was treated with traditional nursing methods, and the intervention group was treated with family-integrated care on the basis of the control group. During the hospital stay, the physical indexes of the two groups of preterm infants were observed and recorded every day, the neonatal growth and development indexes of the two groups before discharge were recorded, and two independent samples were analyzed by t-test. Results The general data of preterm infants in the two groups were balanced at baseline, the weight and body length of preterm infants in the intervention group were higher than those in the control group after the implementation of family-integrated care （P<0.05）, and the head circumference of the intervention group was higher than that of the control group, but the difference was not statistically significant （P>0.05）. Conclusion The educational content of neonatal care should be homogeneous. Standardized family-integrated care promotes the growth and development of premature infants, which is worthy of clinical application.

Objective To study the application effect of "three fixed" emergency mode in emergency rescue of patients with ectopic pregnancy and massive bleeding. Methods A total of 87 patients with ectopic pregnancy and massive bleeding admitted from January 2021 to May 2023 were selected and divided into a routine group （n=45） and a three fixed group （n=42）. The routine group received routine emergency nursing, while the three fixed group received “three fixed”emergency nursing.The evaluation indicators of emergency response timeliness, shock index, emergency nursing satisfaction of the two groups of patients were recorded, and the stress level of nurses before and after intervention, satisfaction of rescue medics, and skill scores of nursing staff were compared. Results The rescue time and total rescue and nursing time of the three fixed group were shorter than those of the routine group, and the total bleeding volume was lower （P<0.05）. The shock index of the three fixed group after intervention was significantly better than that of the routine group （P<0.05）. The nursing satisfaction of patients in the three fixed group was 97.62%, which was higher than 82.22% in the routine group （P<0.05）. The stress score of nurses in the routine group was higher than that in the three fixed group, while the satisfaction score of rescue medics was lower （P<0.05）. The basic abilities, professional first aid skills, and other skills of the nursing staff in the three fixed groups were significantly improved compared to the routine group（P<0.05）. Conclusion The implementation of the“three fixed” emergency mode for patients with ectopic pregnancy and massive bleeding can help improve the efficiency of medical staff's emergency response, relieve shock of patients, reduce the pressure of nursing staff on emergency response, and increase the satisfaction of patients and rescue medics, which is worthy of promotion.

Malakoplakia is a rare, curable, and self-limited chronic granulomatous inflammatory disease. The diagnosis of malakoplakia depends on histopathological examination. Malakoplakia can be treated with strong antibiotics or antibiocits combined with surgery. Case reports of malakoplakia are rarely seen in China at present. It occurs more often in the genitourinary system, and hardly in the vaginal stump. Here we reported the diagnosis and conservative treatment of an elderly female case of vaginal stump malakoplakia, aiming to raise the understanding of the disease.