Androgen insensitivity syndrome (AIS) is a very uncommon genetic disorder that results from the resistance of androgen receptor (AR) to androgen, which influences the formation of the male genitalia and in turn presents with female phenotype.Surgical resection of undesceaded testicle and different kinds of genitoplasty are crucial methods to correct the deformity of reproductive system, as well as hormone replacement therapy, which is an essential therapy for postoperational rehabilitation in AIS patients.A 43-year-old patient, who was socially female, was first admitted to gastroenterology department due to recurrent ascites and occasional abdominal pain with unknown origin.Taking physical examination, ultrasonography, karyotype analysis and sex hormone levels into consideration, the overall manifestations revealed the typical clinical features of complete androgen insensitivity syndrome.After that she was transferred to urology department for laparoscopic gonadectomy.During the surgery, doctors found that there was a vesical fistula on the upper wall near the conjunction between the bladder and ligamenta umbilicale medium, which explained the recurrent ascites for more than 4 years.After resecting the testicles and the tissues around the vesical fistula for histopathology, the result suggested Sertoli cell adenoma, hyperplastic Leydig cells and urothelium atypical hyperplasia.Hormone replacement therapy was given right after discharge.The hormone levels of follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were modulated by the dysfunction of androgen production after gonadectomy and hormone replacement therapy together with psychotherapy could stabilize her hormone levels and improve the quality of her life.The patient was suspicious of AIS family history and the pedigree was made to analyze her family which was possibly X-linked recessive pattern.We propose three possible hypotheses of the fistula, which are direct surgical injury, recurrence of bladder cancer and congenital urachal anomalies.But whether it is relevant between urachal anomalies and AIS is yet to be discovered.

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

Objective: To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods: From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results: The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Objective: To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. Methods: From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. Results: The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. Conclusion The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.

Objective:To construct a new nurse pre-job training program based on transformative learning and explore its preliminary application effect.Methods:A quasi-experimental study was conducted, and 52 new nurses enrolled in 2019 in a three-A hospital of Hangzhou were randomly divided into experimental group ( n=26) and control group ( n=26). The experimental group adopted transformative learning based pre-job training program for new nurses, while the control group adopted traditional pre-job training program for new nurses. SPSS 20.0 and Microsoft Excel 2010 were performed for data processing, and t test and Fisher's exact probability test were used for statistical analysis. Results:After the training, the comparison of two groups of new nurses showed that, the total score of clinical core competence of the experimental group (226.62±32.84) was higher than that of the control group (197.00±29.54), the total score of self-efficacy of the experimental group (28.46±4.94) was higher than that of the control group (24.31±4.76), the total score of the transition shock of the experimental group (77.23±14.13) was lower than that of the control group (91.27±17.98), and the mean value of clinical assessment of the experimental group (73.16±17.05) was higher than that of the control group (61.58±14.24), all with statistical significance ( P<0.05). Conclusion:The pre-job training program for new nurses based on transformative learning can improve the clinical ability and self-efficacy of new nurses, reduce the transition shock of new nurses, and have a profound impact on their career.

Objective: To understand the prevalence of school bullying and depressive symptoms among the Han, Yi, and Tibetan adolescents in western China, and to explore the relationships between bullying roles, bullying frequency and depression symptoms. Methods: A combination method of typical sampling and cluster sampling was used to recruit 3 115 participants from six primary and middle schools in Cangxi County and Ganluo County in Sichuan Province, and Lhasa City in Tibet Autonomous Region from April to November 2020. All participants completed self filled questionnaires. Multiple Logistic regression was used to analyze the association between school bullying and depression symptoms. Results: A total of 881 participants (28.3%) had experienced school bullying in the past 6 months, and 892 participants(28.6%) were detected with depressive symptoms. The rates of school bullying in the Han, Yi, and Tibetan adolescents were 20.5%, 46.4% and 23.8%, respectively. Among them, the rates of victims were 15.3%, 25.0% and 11.8%, respectively; the rates of bully were 2.3%, 5.7% and 6.7%, respectively; the rates of bully victims were 2.9%, 5.7% and 5.4%, respectively. The prevalence of depressive symptoms in the Han, Yi, and Tibetan adolescents were 20.4%, 37.9% and 36.5%, respectively. After adjusting for age, grade, ethnicity, smoking, and drinking, the odds for depressive symptoms among victims ( AOR=1.98, 95%CI =1.61- 2.45 ), bully ( AOR=2.63, 95%CI =1.81-3.82), and bully victims ( AOR=3.33, 95%CI =2.44-4.54) were significantly higher than those without school bullying experience( P <0.01). And the risks increased with the increasing bullying frequency. Conclusion School bullying and depressive symptoms of the Yi and the Tibetan adolescents in western China were higher than those of the Han adolescents. Meanwhile, participation in school bullying and the high frequency of bullying were closely related to depressive symptoms. Future interventions should pay attention to various bullying roles and minority adolescents.

OBJECTIVE: To investigate the prevalence and influencing factors of low back pain in workers in automobile manufacturing plants. METHODS: A judgment sampling method was used to select 394 workers with working length ≥1 year in an automobile manufacturing plant as study subjects. A questionnaire survey was conducted to investigate the prevalence of low back pain in these workers using the Nordic Musculoskeletal Disorders Questionnaire. RESULTS: The prevalence of low back pain in these study subjects was 28. 9%( 114/394). The multivariate logistic regression analysis results showed that the relative risk ranked from high to low is as follow: uncomfortable working posture [Odds ratio( OR) =7. 31,95% confidence interval( 95% CI) = 2. 92-18. 28],feeling tired after work( OR = 5. 34,95% CI = 1. 22-23. 32],the commu time more than 30 minutes( OR = 2. 76,95% CI = 1. 38-5. 52),insufficient operating space( OR = 2. 22,95% CI = 1. 28-3. 83),hand or arm frequently used at work( OR = 2. 08,95% CI = 1. 14-3. 78) and age( OR = 2. 00,95% CI = 1. 19-3. 35),that were all risk factors of low back pain( P < 0. 05). CONCLUSION: The frequent use of hand or arm at work,insufficient operating space,uncomfortable working posture,feeling tired after work,and long commute time are the main influencing factors affecting the low back pain of automobile manufacturing workers.

Objective    To compare the in-hospital outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) for bicuspid aortic valve (BAV) patients and tricuspid aortic valve (TAV) patients. Methods    Patients (including BAV and TAV patients) who underwent TA-TAVR with the J-ValveTM in West China Hospital from July 2014 to July 2020 were included consecutively. The clinical outcomes of the patients were analyzed. Results    A total of 354 patients were included in the study, 75 in the BAV group and 279 in the TAV group. There were 229 males and 125 females with a mean age of 72.2±6.0 years. No death occurred during the procedure, and the overall technical success rate was 97.7%. The all-cause in-hospital mortality rate was 1.4%. Twenty (26.7%) patients with BAV and 46 (16.5%) patients with TAV had mild or higher perivalvular leaks immediately after the procedure. No patients with BAV required permanent pacemaker implantation postoperatively, while 13 (4.7%) TAV patients required permanent pacemaker implantation, with an overall pacemaker implantation rate of 3.7%. One (1.3%) BAV patient and 7 (2.5%) TAV patients developed acute kidney injury postoperatively. One (1.3%) BAV patient and 1 (0.4%) TAV patient developed peri-operative myocardial infarction. The average postoperative hospital stay was 7.6±3.6 d for BAV patients and 8.6±6.1 d for TAV patients. There was no statistical difference in primary or secondary in-hospital outcomes between BAV and TAV patients (P>0.05). Conclusion    Compared to TAV patients, BAV patients have similar in-hospital outcomes, with a low incidence of adverse clinical outcomes, which provides preliminary evidence for its implementation in Chinese patients with a high proportion of BAV.

Dysregulation of circadian rhythms associates with cardiovascular disorders. It is known that deletion of the core circadian gene Bmal1 in mice causes dilated cardiomyopathy. However, the biological rhythm regulation system in mouse is very different from that of humans. Whether BMAL1 plays a role in regulating human heart function remains unclear. Here we generated a BMAL1 knockout human embryonic stem cell (hESC) model and further derived human BMAL1 deficient cardiomyocytes. We show that BMAL1 deficient hESC-derived cardiomyocytes exhibited typical phenotypes of dilated cardiomyopathy including attenuated contractility, calcium dysregulation, and disorganized myofilaments. In addition, mitochondrial fission and mitophagy were suppressed in BMAL1 deficient hESC-cardiomyocytes, which resulted in significantly attenuated mitochondrial oxidative phosphorylation and compromised cardiomyocyte function. We also found that BMAL1 binds to the E-box element in the promoter region of BNIP3 gene and specifically controls BNIP3 protein expression. BMAL1 knockout directly reduced BNIP3 protein level, causing compromised mitophagy and mitochondria dysfunction and thereby leading to compromised cardiomyocyte function. Our data indicated that the core circadian gene BMAL1 is critical for normal mitochondria activities and cardiac function. Circadian rhythm disruption may directly link to compromised heart function and dilated cardiomyopathy in humans.