Volume 104 · Issue 41 · 2024

With the continuous development of science and technology, medical science, and bioengineering technology, various neuromodulation techniques, such as electrical, magnetic, acoustic, and optical modalities, are rapidly emerging in the therapeutic regime of psychiatric disorders. How to choose the appropriate noninvasive brain stimulation techniques for different psychiatric disorders and their clinical features is becoming a practical dilemma in clinical setting. In this paper, by describing the complex pathogenesis of psychiatric disorders and the limitations of existing therapeutic approaches on psychiatric disorders, combining with the characteristics of different neuromodulation techniques, we propose a new strategy of combined noninvasive brain stimulation to intervene in psychiatric disorders: high-intensity stimulation modulating the whole brain without inducing epilepsy should be as the basic treatment of psychiatric disorders, applying low-intensity stimulation with the advantage of specific targets/brain regions to modulate the residual symptoms or/and single symptom, and for refractory and acute psychiatric disorders, ECT/MECT is preferred for rapid symptom control; different noninvasive brain stimulation techniques can be combined with pharmacological and psychotherapeutic treatments, which will provide a new idea for the future development of this field.

To develop and validate a predictive model for postoperative pulmonary complications (PPCs) in elderly patients undergoing non-cardiac surgery.

This retrospective study included 51 354 elderly patients over 65 years old who underwent non-cardiac surgery at the First Medical Center of Chinese PLA General Hospital from January 2009 to December 2018. The patients were randomly divided into a modeling group [n=41 084; 21 550 males, 19 534 females; age: 70 (67, 74) years] and an internal validation group [n=10 270; 5 458 males, 4 812 females; age: 70 (67, 74) years] at a ratio of 4∶1. Additionally, an external validation group of 14 378 patients [7 893 males, 6 845 females; age: 70 (67, 75) years] who underwent non-cardiac surgery at Henan Provincial People′s Hospital between November 2014 and May 2022 was retrospectively included. Multivariate logistic regression were performed to identify factors associated with PPCs. A nomogram prediction model was constructed based on these factors and validated internally and externally. The model′s performance and clinical applicability were assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curves.

Among the 51 354 elderly patients underwent general anesthesia for non-cardiac surgery, the incidence of PPCs was 17.5% (9 008/51 354). Multivariate logistic regression analysis reveals that anesthesia duration 130-<183 min (OR=1.858, 95%CI: 1.529-2.266), anesthesia duration 183-<250 min (OR=2.537, 95%CI: 2.079-3.108), anesthesia duration≥250 min(OR=3.533, 95%CI: 2.868-4.368), crystalloid infusion volume 1 400-<2 000 ml (OR=1.481, 95%CI: 1.204-1.829), crystalloid infusion volume 2 000-<9 000 ml (OR=1.776, 95%CI: 1.426-2.220), upper abdominal surgery (OR=1.658, 95%CI: 1.498-1.835), malignancy (OR=1.796, 95%CI: 1.606-2.012), fentanyl dosage 0.40-<0.55 mg (OR=1.404, 95%CI: 1.203-1.640), fentanyl dosage≥0.55 mg (OR=1.601, 95%CI: 1.386-1.854), prophylactic use of antibiotics (OR=7.897, 95%CI: 5.124-12.983), age (OR=1.039, 95%CI: 1.030-1.049), smoking (OR=1.124, 95%CI: 1.014-1.246), preoperative chest X-ray abnormalities (OR=2.139, 95%CI: 1.820-2.509) and intraoperative hypotension (OR=3.184, 95%CI: 2.120-4.795) were risk factors for PPCs, while elective surgery (OR=0.301, 95%CI: 0.220-0.417) was a protective factor. The nomogram model incorporating these factors had an area under the curve (AUC) of 0.757 (95%CI: 0.748-0.766, P=0.309) in the modeling group, 0.779 (95%CI: 0.760-0.796, P=0.171) in the internal validation group, and 0.778 (95%CI: 0.763-0.792, P<0.001) in the external validation group. Calibration curves and decision curves demonstrated good consistency and benefit of the model.

The nomogram model which based on anesthesia duration, crystalloid infusion volume, upper abdominal surgery, malignancy, fentanyl dosage, prophylactic use of antibiotics, age, smoking, preoperative chest X-ray abnormalities, intraoperative hypotension and elective surgery provides strong predictive value and clinical utility for assessing the risk of PPCs in elderly patients undergoing non-cardiac surgery.

To explore the feasibility of using the entry point and screw path parameters of sacroiliac (S₂AI) screws inserted under O-arm 3D computer navigation as a reference for freehand screw insertion in patients with degenerative spinal deformities.

A retrospective analysis was conducted on the clinical data of 66 patients with degenerative spinal deformities who received S₂AI screw fixation assisted by the O-arm 3D computer navigation system at Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2017 to April 2022. The patients included 6 males and 60 females, with a mean age of (64.3±5.9) years. Preoperatively, the entry point was set as the intersection of 1 mm from the outer and lower edges of the S₁ foramen, adjusted intraoperatively by navigation, and verified postoperatively by full spinal CT scans and 3D reconstructions. Using the S₁ screw entry point as the origin, the position of the bilateral S₂AI screw entry points, tailward angulation (SA), outward angulation (TA), and vertical distance from the entry point to the skin (SD) were measured on postoperative CT 3D images. The accuracy of S₂AI screw placement and any intraoperative and postoperative complications were recorded. Differences in entry point coordinates and screw path parameters between the left and right sides were compared. The intraclass correlation coefficient (ICC) was used to assess intra-observer and inter-observer agreement.

The coordinates and screw path parameters for the S₂AI screws placed using the O-arm navigation demonstrated good intra-observer and inter-observer consistency (ICC>0.75). The left entry point was located (8.08±1.39) mm laterally and (24.47±2.20) mm caudally from the S₁ entry point, while the right entry point was (8.09±1.41) mm laterally and (24.40±2.54) mm caudally, with no significant difference between the left and right sides (both P>0.05). The left TA was 46.33°±3.44°, SA was 39.14°±6.12°, and SD was (60.38±13.37) mm; the right TA was 46.37°±3.41°, SA was 39.59°±5.89°, and SD was (60.30±12.24) mm, with no significant differences between the left and right parameters (all P>0.05). There was no significant neurovascular complications intraoperatively or two weeks postoperatively, with a screw insertion accuracy of 97.7% (129/132).

In the fixation of the pelvis in degenerative spinal deformities, the use of O-arm navigation-assisted S₂AI screw insertion has a high accuracy rate. It is recommended that for freehand screw insertion, the entry point should be located 24 mm caudally and 8 mm laterally from the outer and lower edges of the superior articular process of S₁, with an TA of approximately 46° and a SA of approximately 39°.

Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis (ACS).

A cohort study. A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi′an Jiaotong University between May 2021 and January 2023. Based on the auxiliary systems, the patients were divided into two groups: the S8 navigation system-assisted correction group (navigation group, n=20) and the C-arm-assisted manual correction group (manual group, n=28). The primary outcome measures were coronal balance (CB), sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL), and the Scoliosis Research Society-22 (SRS-22) questionnaire. The secondary outcome measures included surgery-related conditions and postoperative complications.

Of the 48 patients, there were 21 males and 27 females, with a mean age of (13.3±3.0) years. There was no statistically significant differences in preoperative distance of C₇ plumb line to center sacral vertical line (C₇PL-CSVL), SVA, LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). Postoperatively, the C₇PL-CSVL and SVA in the navigation group were both better than in the manual group [(12.51±11.86) mm vs (19.64±1.33) mm, (15.72±3.64) mm vs (25.42±2.53) mm, both P<0.05]. There was no statistically significant differences in postoperative LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17% (93/102) and 95.09% (97/102) in the navigation group, respectively, which were higher than those in the manual group [84.45% (125/148) and 91.89% (136/148), respectively] (both P<0.05). The rates of adjacent facet joint violation in Grades A, B, and C were 88.23% (90/102), 11.76% (12/102), and 0 (0/102) in the navigation group, respectively, which were all better than those in the manual group [83.44% (121/145), 8.96% (13/145), and 7.58% (11/145)] (P=0.015). The navigation group had shorter operative time, single screw placement time, and total screw placement time, and the distance between the screws and the cortex was closer compared to the manual group (all P<0.05). Intraoperative blood loss in the manual group was higher than that in the navigation group (P<0.05). The average curve correction rate in the navigation group (74.68%±10.70%) was better than that in the manual group (59.60%±6.90%) (P<0.001). The intraoperative fluoroscopy dose in the navigation group was higher than that in the manual group [(416±70) mGy vs (360±81) mGy, P=0.015]. The incision length in the navigation group was longer than that in the manual group (P<0.05). There was no statistically significant difference in preoperative VAS pain score between the two groups (P>0.05). The postoperative visual analogue scale scores of pain on day 3 was better in the navigation group [(2.60±0.22) vs (3.10±0.32), P<0.001], while there was no statistically significant differences at other time points between the two groups (all P>0.05). No complications occurred in either group.

The S8 navigation system demonstrates good corrective outcomes, high screw placement accuracy, low facet joint violation, and favorable clinical results in the treatment of adolescent congenital scoliosis, making it an ideal auxiliary tool.

To compare the accuracy and efficiency between the model development method and the software development method, which design and develop 3D printed integral anatomical acetabular prosthesis to be used in total hip arthroplasty(THA) for patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip(DDH).

Fifteen patients with end-stage hip osteoarthritis due to Crowe type Ⅱ and Ⅲ DDH who underwent THA in the Orthopedics Department of the First Affiliated Hospital of Bengbu Medical College between January 2015 and June 2023 were selected in this study retrospectively. There were 1 male (1 hip) and 14 females (17 hips) with a mean age of (55.1±9.1) years. There were 12 hips with Crowe type Ⅱ, 6 hips with Crowe type Ⅲ. The preoperative pelvis three-dimensional CT data in those patients were used to design integral anatomical acetabular prosthesis. The model development group used 3D printing technology to print life-size pelvis models. The acetabulum was reamed and the acetabulum cup was inserted into the socket according to conventional THA procedures. The bone defect above the acetabulum cup was filled with bone wax. The Mimics and 3-matic software were used to simulate the THA procedures, design and install the integrated anatomical acetabular prosthesis in the software development group. The operation time, the size of the acetabular cup, the volume and surface area of the acetabulum bone defect, the acetabular cup′s inclination and anteversion, the horizontal distance and the vertical distance of hip rotation center were compared between the two methods.

The study in the two groups were all based on the data of 18 hips in the 15 patients. The horizontal and vertical distances of rotation center in the model development group and software development group was (32.08±1.80) mm, (32.17±2.40) mm and (14.36±1.53) mm, (15.11±1.45) mm, respectively (both P>0.05). The cup size in model development group was (48.56±1.15)mm, and it was (48.77±1.22) mm in the software group (P=0.160). The anteversion and inclination of the acetabular cup in the model and software groups were 23.79°±6.31°, 30.49°±11.03° and 15.17°±0.52°, 40.24°±0.58°, respectively (both P<0.01). The volume and surface area of the acetabulum bone defect in the model development group was (5.06±2.86) mm³ and (8.31±2.21) mm², respectively, while it was (4.01±2.56)mm³ and (6.83±2.71) mm², respectively, in the software development group (both P<0.05). The work time in the model development group was (24.43±0.68) h and (0.47±0.12) h in the software development group, respectively (P<0.001).

Compared with the 3D printing model development method, the application of Mimics and 3-matic software to design and develop integrated anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ DDH show advantages of convenience, high efficiency and more accuracy.

To study biological variation (BV) and analytical performance specifications (APS) of 15 erythrocyte and related parameters.

Sixty healthy participants from Beijing Hospital were prospectively recruited for the study, from July to December, 2023, including 30 males [aged (41.3±11.9) years] and 30 females [aged (40.3±12.4) years]. The study was designed based on the Biological Variation Data Critical Appraisal Checklist and the characteristics of erythrocyte detection. Whole blood samples were collected 10 times at 2-week intervals during 20 weeks. All samples were tested in duplicate using Mindray BC-7500 hematology analyzer and its accompanying reagents. Within-subject biological variation (CV_I) and between-subject biological variation (CV_G) were estimated by the nested ANOVA method. The BV data in this study were compared with the BV data of the European Database of Biological Variation. APS, reference change value (RCV) and index of individuality (II) were calculated.

The CV_I for 15 parameters ranged from 0.49% to 86.46%, and the CV_I data for red cell distribution width (RDW)-CV, RDW-SD, reticulocyte (RET) percentage, RET count, reticulocyte hemoglobin content (RHE), medium fluorescence reticulocyte (MFR) and high fluorescence reticulocyte (HFR) were significantly higher in females than in males (all P<0.05). The CV_G ranged from 1.27% to 100.79%, and the CV_G data for HFR were significantly different between genders (P<0.05). The CV_I data for red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and RHE in this study were lower than those recommended by the European database. The derived indicators of most parameters were influenced by gender. The II values for all parameters were<1.4, where the II values of MCHC and HFR were between 0.6 and 1.4; the II values for the remaining 13 parameters were<0.6.

A BV study protocol for erythrocyte parameters is designed. When the reference intervals differ between genders, BV data should be calculated separately and the lower BV data are recommended for calculating APS; the RCV should be set separately for each gender.

To analyze the treatment-free remission (TFR) outcomes in patients with chronic myeloid leukemia (CML) treated sequentially with nilotinib (NIL) after achieving deep molecular response (DMR) to imatinib (IM).

Retrospectively enrolled 103 CML patients from 6 hematological centers in Henan Province who chose sequential NIL therapy or continued IM therapy after achieving DMR to first-line IM from June 2, 2013 to August 30, 2022. Among them, 42 cases were treated with sequential NIL and 61 cases continued IM therapy. The 42 patients in the sequential NIL group were further divided into 3 subgroups based on the duration of DMR at switching to sequential NIL therapy: Group 1 (17 cases): DMR duration<12 months at switching to sequential NIL therapy; Group 2 (8 cases): DMR duration≥12 months to<24 months at switching to sequential NIL therapy; Group 3 (17 cases): DMR duration≥24 months at switching to sequential NIL therapy. Follow-up ended on January 9, 2024, with a median follow-up of 40 (16, 91) months for the sequential NIL group and 49 (21, 123) months for the continuous IM group. Survival curves were plotted using the Kaplan-Meier method and the log-rank test was performed to compare the TFR rates between groups.

There were 19 males and 23 females with a median age [M (Q₁, Q₃)] of 43 (31, 50) years in the sequential NIL group. There were 32 males and 29 females with a median age of 41 (31, 50) years in the continuous IM group. Kaplan-Meier survival curve analysis showed that the TFR rate was higher in the sequential NIL group than in the continuous IM group (88.1% vs 63.9%, P=0.005). The results of subgroup analysis showed that the TFR rates in Group 1, Group 2 and Group 3 were 94.1%, 87.5% and 82.4%, respectively, with no statistically significant differences (all P>0.05).The TFR rate in Group 1 was higher than in the continued IM group (P=0.017), and there were no statistically significant differences in Group 2 and Group 3 compared with the continuous IM group(all P>0.05).

Sequential NIL therapy after achieving DMR with IM therapy can improve the TFR rate in CML patients, especially in those with DMR duration<12 months before switching to sequential NIL therapy.

To analyze the effect of single pigtail bile duct stents without lateral wings bile duct drainage after removal of common bile duct stones in endoscopic retrograde cholangiopancreatography (ERCP).

Patients who underwent ERCP and implantation of a single pigtail bile duct stent for choledocholithiasis in Cholelithic Center of East Hospital Affiliated to Tongji University from January 2019 to September 2023 were retrospectively selected and divided into lateral wingless group (without the lateral wing) and lateral wing group(with the lateral wing) according to whether the lateral wings of the single pigtail bile plastic stents were preserved. The patients were followed up for 1 to 3 months. The stent detachment rate at 2 days, 1 week and 1 month, as well as the incidence of postoperative complications at 1 week and 1 month after ERCP were compared between the two groups.

A total of 402 patients were included, including 177 males and 225 females, aged 32-83 (58±12) years. There were 215 cases in the lateral wingless group and 187 cases in the lateral wing group. The stent detachment rate in the lateral wingless group was higher than that in the lateral wing group at 2 days after ERCP [12.6% (27/215) vs 5.9% (11/187), P=0.022]. The stent detachment rate in the lateral wingless was higher than that in the lateral wing group at 1 week after ERCP [87.0% (187/215) vs 25.1% (47/187), P<0.001]. The stent detachment rate in the lateral wing group was higher than that in the lateral wing group at 1 month after ERCP [97.2% (206/215) vs 67.3% (126/187), P<0.001]. The incidence of postoperative complications at 1 week after ERCP revealed no statistical significance between the two groups[(10.7% (23/215) vs 8.6% (16/187), P>0.05]. The incidence of postoperative complications at 1 month after ERCP in the lateral wingless group was lower than that in the lateral wing group [0.9% (2/215) vs 9.6% (18/187), P=0.001].

After the removal of choledocholithiasis with ERCP, bile is drained by a single pigtail bile duct stent with lateral removal, which has a high rate of natural shedding and a low incidence of complications.

To analyze the clinical efficacy and its influencing factors of ustekinumab (UST) in the treatment of patients with Crohn′s disease (CD). From January 2021 to January 2024, CD patients who received UST treatment were retrospectively collected from the Second Affiliated Hospital of Wenzhou Medical University. Harvey-Bradshaw index were applied to assess clinical activity of CD patients, C-reactive protein was used to evaluate biochemical remission rate, and simplified Crohn′s disease endoscopy score was used to evaluate the degree of intestinal inflammation. Logistic regression model was used to analyze the influencing factors for the clinical response rate at week 8, as well as the clinical remission rate and endoscopic remission rate at week 32. A total of 138 CD patients were included, including 93 males and 45 females. The age of diagnosis [M (Q₁, Q₃)] was 24 (19, 32) years old. At week 8, the clinical response rate and biochemical remission rate was 58.0% and 49.3%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical response rate at week 8 (OR=0.46, 95%CI: 0.23-0.95). The clinical remission rate and endoscopic remission rate at week 32 were 56.5% and 37.7%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical remission rates (OR=0.18, 95%CI: 0.08-0.42) and endoscopic remission rates (OR=0.25, 95%CI: 0.11-0.55) at week 32. Failure to achieve clinical response at week 8 was the risk factor of the clinical remission rates (OR=0.21, 95%CI: 0.09-0.52) and endoscopic remission rates (OR=0.19, 95%CI: 0.07-0.50) at week 32. UST treatment has good clinical efficacy in CD patients. CD patients with intestinal stenosis or penetrating lesions can decrease the efficacy of UST treatment. Failure to achieve clinical response at week 8 can decrease the efficacy at week 32.

To explore the efficacy of domestic single-hole robotic surgery system in the treatment of pediatric urological diseases. A prospective review of clinical data of children who underwent laparoscopic surgery in the Department of Urology, Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University, was conducted from July to November 2023. All surgeries were performed using the sharp single-port serpentine arm robotic surgery system, with an umbilical access route. All surgeries are performed by the same chief physician. Operative time, intraoperative blood loss, incision size, and postoperative complications were recorded. A total of 12 patients were included, consisting of 8 males and 4 females, aged 8.0-17.0 (13.5±2.7) years. The procedures included 5 pyeloplasties (1 case of bilateral pyeloplasty), with a unilateral operative time [M (Q₁, Q₃) ]of 180 (145, 200) minutes and a blood loss of 5 (5, 10) ml. Oral mucosa ureteroplasty was performed in 1 patient, taking 3 hours and 52 minutes with a blood loss of 10 ml. Renal cyst decortication was conducted in 1 case in 85 minutes with a blood loss of 20 ml. High ligation of the spermatic vein was conducted in 3 patients, with an average operative time of 97 minutes and no intraoperative blood loss. Bilateral gonadectomy was completed in 80 minutes with a blood loss of 5 ml. Ovarian cystectomy (1 case) was performed in 69 minutes with a blood loss of 5 ml. All surgeries were successfully completed without conversion to open surgery. Except for the oral mucosa ureteroplasty, which required an additional 5 mm auxiliary port, all procedures were performed through a 3 cm umbilical incision. Among the patients who underwent pyeloplasty, 1 case of urinary leak was identified and successfully treated conservatively with adequate drainage over 25 days. Re-stenosis was experienced by 1 patient with a long segment ureteral stricture postoperatively, while no Clavien-Dindo grade≥2 complications were observed in other patients. All umbilical wounds were concealed, and satisfactory postoperative appearances were noted. The domestic single-hole robotic surgery system is effective in treating pediatric urological diseases.

The patient, a 78-year-old male, was seen in Beijing Anzhen Hospital on March 1, 2024 mainly due to "eyelid ptosis, diplopia for more than 20 years, limb weakness for 10 years, aggravation with dysphagia for half a year". The neostigmine test was positive in other hospitals, and the diagnosis was myasthenia gravis (MG), which was improved by glucocorticoid and pyridostigmine bromide treatment. Later, the symptoms and signs of lower motor neuron injury, such as limb weakness, dysphagia, muscle atrophy and hyporeflex, gradually appeared. The electromyographic nerve conduction velocity of this admission showed a decrease in motor conduction amplitude of bilateral ulnar nerve, bilateral median nerve and right common peroneal nerve, cerebrospinal fluid showed protein-cell separation, serum acetylcholine receptor (AChR) antibody was positive, serum ganglioside antibody GM1-lgM and GT1a-lgG were positive, and the final diagnosis was MG combined with pure motor chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Symptoms improved slightly after administration of intravenous gamma globulin (IVIg). MG patients may have CIDP at the same time, which should be fully understood and diagnosed and treated as soon as possible.

Trichosporidium asashi (asahii, T.) is a fungus, which is a conditional pathogen of patients with immunocompromise, immunodeficiency and hematological malignancies. In the acute phase of disseminated infection, multiple organs can be quickly involved, causing bacteremia, shock, etc., and the mortality rate can be as high as 80%. In recent years, research has shown that China isasahii, T.High-incidence areas of infection.asahii, T.It is considered an important pathogen in immunocompromised patients, which is insensitive to most antifungal drugs other than triazoles. Voriconazole vs. Posaconazole as treatmentasahii, T.One of the drugs of choice for infections. With long-term treatment and repeated dosing,asahii, T.The degree of drug resistance is becoming more and more serious, and related studies and reports are also increasing. This paper is based onasahii, T.Epidemiological and drug susceptibility data, onasahii, T.The latest research progress on pathogenic and drug resistance mechanisms is reviewed in order to provideasahii, T.Treatment strategies provide reference, reducingasahii, T.Case mortality of infections.

With the rapid development of digital technology, its application and research in the management of diabetes mellitus at the grass-roots level have also made remarkable progress. Through remote monitoring, digital management, big data and artificial intelligence, digital management not only improves the accessibility and efficiency of primary medical services, but also helps to improve patients' self-management ability and realize personalized treatment. However, the promotion and application of digital management in grassroots diabetes management still faces some challenges. In the future, it is necessary to further improve the functions and security of digital management tools to provide better medical services for grassroots diabetic patients.

The patient, a 43-year-old female, went to the Department of Neurology, the Third Hospital of Hebei Medical University for "weakness of right lower limb accompanied by walking and stepping on cotton for one and a half years". One and a half years ago, the patient developed weakness of the right lower limb accompanied by the feeling of stepping on cotton while walking, and the local flaky numbness area of the right hypochondrion gradually expanded to the anterior side of the right lower limb, and the above symptoms gradually worsened. Previous diagnosis of lumbar disc herniation due to intermittent low back pain with radiating pain in the left lower limb for 6 years. Physical examination: clear, no obvious abnormalities in cranial nerves, right lower limb muscle strength grade III, remaining limb body muscle strength grade V, limb muscle tone acceptable, right lower limb knee tendon reflex active, both upper limbs and left lower limb knee tendon reflex normal, bilateral ankle reflex disappeared, right T₈~ L₃Horizontal hypoalgesia, weakened vibration sensation of tuning forks in both lower limbs, positive bilateral Pap sign, low skin temperature with mild cyanosis in the left lower limb, and normal urine and stool. The patient's thoracic spine MRI plain scan showed T_3~4The subarachnoid space at the anterior edge of the horizontal spinal cord disappeared, the spinal cord moved forward, the spinal cord in the diseased segment became thin, flattened, curved at an angle, and the subarachnoid space behind the corresponding horizontal spinal cord widened (Figures 1~3, shown by arrows). This patient mainly presented with atypical spinal cord hemisection injury. In addition, there were bilateral pyramidal tract damage, hypothermia of contralateral limbs, cyanotic skin color and other signs of autonomic nerve damage. Combined with MRI sagittal position showing T₃The horizontal spinal cord is advanced, thinned, with a "C" shape change, and the dorsal subarachnoid space is enlarged without tumor formation. It is also different from the characteristics of "knife incision sign" caused by arachnoid mesh band, so it is considered as spinal hernia. Spinal hernia is a clinical manifestation of a series of spinal cord compression caused by anterior or anterior lateral herniation of the spinal cord through the defective dura mater. The disease mostly starts slowly, and the most common sign is Brown-Sequard syndrome, which is characterized by pain and temperature disturbance in one limb, weakness in the contralateral limb with impaired proprioception such as vibration and position sensation. The most common sites of spinal cord hernias are located in T_2~10Horizontal, spinal cord MRI sagittal lesion segment spinal cord has a "C" nodular shape, and the dorsal subarachnoid space is enlarged. Typical spinal cord hernia can show spinal cord herniation out of the subdural space in MRI transverse position, showing "double spinal cord sign". The treatment measures of this disease are mainly through surgery to directly suture the hernia mouth, hernia sac enlargement and hernia sac dura repair to improve the symptoms.

A 45-year-old male went to the Second Affiliated Hospital of Xi' an Jiaotong University for "right knee pain for 2 months". The patient experienced right knee joint pain 2 months ago, which was aggravated when moving and relieved when resting. There was no bouncing, no interlocking, no swelling, and no significant relief was seen after oral medication. The physical examination of the knee joint showed no obvious abnormalities in the appearance of both knee joints, no varus deformity, positive tenderness in the medial joint space of the right knee joint, normal joint mobility, negative medial and lateral stress test, negative anterior drawer test, negative posterior drawer test, negative medial grinding test, negative lateral grinding test, negative Lachman test, and negative axial shift test. X-ray examination of the right knee showed calcification of the soft tissue in the medial condyle of the right medial femur (Figure 1, indicated by arrows). MRI of the right knee showed abnormal signals in the out-of-shape area of the medial collateral ligament (MCL) of the right knee, considering the possibility of injury; Bone marrow edema of the right medial femoral condyle; Subcutaneous soft tissue edema of the right knee (Figure 2, shown by arrows). Considering the possibility of diagnosis of knee MCL calcification (Pellegrini-Stieda syndrome), the preoperative routine laboratory tests were improved, and no obvious surgical contraindications were found. Arthroscopic microfracture of medial femur of right knee + resection and reconstruction of MCL lesions were performed under subarachnoid block anesthesia. Intraoperative pathological diagnosis: "right MCL" calcified nodule. After operation, the patient was given treatment such as analgesia, swelling reduction, acid suppression and infection prevention. He wore braces and actively performed functional exercises. At the re-examination 3 months later, the patient claimed that he had recovered well, and no obvious positive signs were found on physical examination. MRI of right knee joint showed that MCL signal was slightly increased; A small amount of fluid accumulation in the joint cavity of the right knee. The knee MCL calcification sign is defined as a combination of imaging manifestations of MCL at or near the proximal insertion of the medial femoral condyle and concomitant medial knee pain or limited range of motion. In this case, the patient had pain in the right knee joint, and the X-ray film showed calcification of the medial soft tissue of the medial femoral condyle. Combined with the intraoperative pathological diagnosis of "right MCL" calcified nodule, the sign of MCL calcification in the knee joint was confirmed.