Objective To investigate the distribution characteristics of model numbers associated with the third-generation Oxford unicompartmental knee arthroplasty(UKA)prostheses,in order to provide evidence-based guidance for the selection of appropriate UKA prostheses in clinical practice.Methods A retrospective analysis was conducted on data from 270 patients who underwent UKA using third-generation Oxford prostheses and fulfilled the inclusion criteria between April 2019 and September 2023.Patient characteristics,including gender,age,height,weight,affected side,and prosthesis model numbers,were collected and recorded.The distribution and matching patterns of femoral and tibial prosthesis model numbers were evaluated.Multiple ordinal logistic regres-sion analyses and receiver operating characteristic(ROC)curves were employed to identify significant predictors influencing the selection of femoral component models.Additionally,a parameter distribution map related to UKA prosthesis model numbers was developed.Results Among the femoral prostheses,the XS size accounted for 21.5％,S for 44.1％,M for 26.3％,and L for 8.1％.Regarding tibial prostheses,AA represented 11.1％,A 23.7％,B 29.3％,C 18.9％,D 10.4％,and E 6.7％.The matching rates between tibial and femoral components were as follows:93.3％for tibial AA corresponding to femoral XS,96.0％for tibial A/B corresponding to femoral S,95.8％for tibial C/D corresponding to femoral M,and 91.7％for tibial E corresponding to femoral L,resulting in an overall matching rate of 95.2％.Height(AUC=90.63％),gender(AUC=81.59％),and weight(AUC=84.47％)showed significant correlations with femoral model selection(P＜0.01),whereas age and side did not demonstrate statistical significance.The S femoral model was predominantly used in female patients(59.6％),while the M and L models were more commonly utilized in male patients(65.2％).When female patients' height was ≤160 cm,the combined usage rate of the XS and S models exceeded 90％.For male patients taller than 175 cm,the utilization rate of the L model reached 88.9％.The accuracy rate of preoperative prediction based on height and gender was 70.7％,which improved to 77.0％when incorporating intraoperative tibial model information.Conclusions The distribution of UKA prostheses in the study population differed from that observed in Western populations,as well as from other regions in Asia and China.The distribution map of UKA prostheses and the corresponding matching rules established in this study demonstrate a high level of predictive accuracy,which can effectively support preoperative planning and intraoperative selection of femoral prosthesis model numbers.

Objective To investigate the distribution characteristics of model numbers associated with the third-generation Oxford unicompartmental knee arthroplasty(UKA)prostheses,in order to provide evidence-based guidance for the selection of appropriate UKA prostheses in clinical practice.Methods A retrospective analysis was conducted on data from 270 patients who underwent UKA using third-generation Oxford prostheses and fulfilled the inclusion criteria between April 2019 and September 2023.Patient characteristics,including gender,age,height,weight,affected side,and prosthesis model numbers,were collected and recorded.The distribution and matching patterns of femoral and tibial prosthesis model numbers were evaluated.Multiple ordinal logistic regres-sion analyses and receiver operating characteristic(ROC)curves were employed to identify significant predictors influencing the selection of femoral component models.Additionally,a parameter distribution map related to UKA prosthesis model numbers was developed.Results Among the femoral prostheses,the XS size accounted for 21.5％,S for 44.1％,M for 26.3％,and L for 8.1％.Regarding tibial prostheses,AA represented 11.1％,A 23.7％,B 29.3％,C 18.9％,D 10.4％,and E 6.7％.The matching rates between tibial and femoral components were as follows:93.3％for tibial AA corresponding to femoral XS,96.0％for tibial A/B corresponding to femoral S,95.8％for tibial C/D corresponding to femoral M,and 91.7％for tibial E corresponding to femoral L,resulting in an overall matching rate of 95.2％.Height(AUC=90.63％),gender(AUC=81.59％),and weight(AUC=84.47％)showed significant correlations with femoral model selection(P＜0.01),whereas age and side did not demonstrate statistical significance.The S femoral model was predominantly used in female patients(59.6％),while the M and L models were more commonly utilized in male patients(65.2％).When female patients' height was ≤160 cm,the combined usage rate of the XS and S models exceeded 90％.For male patients taller than 175 cm,the utilization rate of the L model reached 88.9％.The accuracy rate of preoperative prediction based on height and gender was 70.7％,which improved to 77.0％when incorporating intraoperative tibial model information.Conclusions The distribution of UKA prostheses in the study population differed from that observed in Western populations,as well as from other regions in Asia and China.The distribution map of UKA prostheses and the corresponding matching rules established in this study demonstrate a high level of predictive accuracy,which can effectively support preoperative planning and intraoperative selection of femoral prosthesis model numbers.

Objective:To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction, who were admitted to Tianjin hospital between May 2013 and January 2023, including 5 males and 15 females, aged 61-84 years [(72.2±7.3)years]. According to Letournel and Judet classification, 13 patients had anterior column fracture, 5 anterior column fracture combined with posterior transverse fracture and 2 two-column fracture. All the patients underwent open reduction and internal fixation through an anterior approach. Of them, 11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum (plate plus raft screw group) and 9 with the screws only (screw only group). The operative time, intraoperative blood loss, and intraoperative fluoroscopy times were compared between the two groups. The quality of fracture reduction was evaluated with the Matta′s radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D′Aubigné and Postel scoring system at 3 months after surgery and at the last follow-up as well as the excellent and good rate at te last follow-up. The occurrence of postoperative complications was observed.Results:All the patients were followed up for 6-18 months [(13.1±3.1)months]. There were no significant differences in the operative time, intraoperative blood loss or intraoperative fluoroscopy times between the two groups ( P>0.05). According to the Matta′s radiographic criteria at 3 days after surgery, patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group, compared to 5 and 4 respectively in the screw only group ( P>0.05). The values of Merle D′Aubigné and Postel score at 3 months after surgery and at the last follow-up were (14.0±2.4)points and (15.8±2.2)points in the plate plus raft screw group, which were higher than those in the screw only group [(11.0±2.6)points and (13.0±3.1)points] ( P<0.01). The values of Merle D′Aubigné and Postel score at the last follow-up of both groups were further enhanced from those at 3 months after surgery ( P<0.01). At the last follow-up, 3 patients were rated excellent, 6 good, 1 fair and 1 poor in the plate plus raft screw group, with an excellent and good rate of 81.8%, while in the screw only group, 3 were rated good, 2 fair and 4 poor, with an excellent and good rate of 33.3% ( P<0.05). One patient in the plate plus raft screw group and 5 in the screw only group had displacement of the dome impaction fragment combined with traumatic arthritis after surgery ( P<0.05). Conclusion:For acetabular fractures combined with dome impaction in the aged patients, the horizontal plate plus raft screw above the acetabulum can effectively improve the function restoration of the hip joint and reduce the occurrence of the displacement of the dome impaction fragment and traumatic arthritis after surgery compared to the fixation with screws only.

Immunotherapy has become the cornerstone of current malignant tumor treatment.However,the response of different patients to immunotherapy is highly heterogeneous,and not all patients can benefit from it.There is an urgent need to find biomarkers that can effectively predict the efficacy of immunotherapy.C-C chemokine ligand 4(CCL4)is a cytokine,belonging to the inflammatory CCL subfamily.It is mainly secreted by immune cells and tumor cells and shows low or no expression in normal tissues but abnormally high expression in various malignant tumor tissues.After binding to CCL4 and its receptor C-C chemokine receptor type 5(CCR5),it can recruit and mediate immune cell migration,destroy the stabili-ty of the tumor microenvironment(TME),participate in carcinogenesis and promote the development of tumors.In the tumor immune microenvironment,CCL4 can mediate and recruit the directed migration of key immune cells such as monocytes,macrophages,natural killer(NK)cells,and T cells,which makes it a potentially important element affecting the efficacy of im-munotherapy and has specific value.This paper reviews the research progresses of CCL4's effects on immune escape in TME,in order to provide clues and references for basic research and clinical diagnosis and treatment.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective:To evaluate the clinical outcome of Robot-assisted sacroiliac screw fixation in the treatment of fragility fracture of the sacrum in the elderly.Methods:From March 2016 to June 2022, a retrospective analysis was performed on 30 patients with fragility fractures of the sacrum in the elderly who accepted robot-assisted sacroiliac screw to treat fragility fractures of the sacrum in our hospital. There were 12 males and 18 females with average age 71.03±8.25 years (range, 60-89 years). According to the classification of fragility fractures of the pelvis (FFP) in the elderly, there were 22 patients with FFP II, 2 patients with FFP III, and 6 patients with FFP IV. Surgical planning was based on the average CT value of S 1 channel and whether there is a transsacral screw channel. Robot-assisted sacroiliac screw fixation was performed during surgery. The pain of pre-operation and post-operation was evaluated using the visual analogue scale (VAS), the position of sacroiliac screws was evaluated by Gras grading, and the degree of functional recovery after surgery was evaluated using the Majeed function score. Results:All 30 patients successfully completed the operation. The mean operation time was 27.00±6.68 min (range, 18-35 min), the mean fluoroscopy times were 27.13±5.16 (range, 18-34), and the mean blood loss was 30.53±6.61 ml (range, 23-38 ml). All patients were followed up, and the mean follow-up time was 19.03±7.8 months (range, 8-25 months). The VAS was 5(5, 6), 4(3, 4), 3(2, 3), 0(0, 1) points before surgery, 1 week, 2 months and 6 months after surgery, respectively, and the difference was statistically significant ( H=103.26, P<0.001). After the surgery of 2 months, 6 months and the last follow-up time, the Majeed function scores were 88(83, 90), 91(87, 92), 92(90, 93) points, respectively, and the difference was statistically significant ( H=19.59, P<0.001). Screw position was evaluated according to Gras grading at 3 days after surgery, including 28 cases of level I, 2 cases of level II, and no screw penetrated the cortical bone or entered the sacral canal or sacral foramen. No vascular or nerve injury occured during the operation. 28 patients with FFS met the fracture healing criteria, and the healing time was 4.54±1.57 months (range, 3-7 months). Two patients had bone nonunion, one of whom underwent anterior ring plate removal due to infection of the pelvic anterior wound, and one month later, pelvic CT scan revealed loosening of the sacroiliac screw; the other one is considered to be related to too early weight bearing. Conclusion:For fragility fractures of the sacrum in elderly, Robot-assisted sacroiliac screw is an effective minimally invasive treatment, with high accuracy of screw placement, effective pain reduction, improved fracture healing rate, and achieve the satisfactory clinical efficacy.

Objective:To investigate the clinical efficacy of robot-assisted sacroiliac screw implantation in the treatment of proximal dysplasia sacral fractures.Methods:A retrospective analysis was conducted on 191 patients admitted to the Pelvic Department of Tianjin Hospital from May 2016 to January 2021 who underwent robot assisted sacroiliac screw implantation with sacral fractures, including 105 males and 86 females, aged 38.5±6.5 years (ranging from 19 to 69 years old). Among them, there were 85 patients with dysplasia of proximal sacrum. According to the classification of proximal sacral dysplasia, the patients were divided into five groups: the steep sacral alar slope group ( n=60), the mastoid protrusion group ( n=30), the lumbar sacralization group ( n=25), the sacral foramen oval degeneration group ( n=23) and the S 1 anterior cortical depression group ( n=10). The remaining 106 patients were normal group. Iliac cortical density (ICD) line typing was recorded in the 85 patients. The the completion of sacroiliac screw implantation, the Gras score of screw position after operation, the postoperative complications, the minimum diameter of S 1 screw channel (R1), the angle ∠A between the S 1 sacroiliac screw in the coronal plane and the cephalic side, and the angle ∠B between the S 1 sacroiliac screw in the water plane and the ventral side were recorded and compared with those of normal development patients. Results:The incidence of steep sacral alar slope was the highest (31.4%, 60/191). There were 2 or more developmental abnormalities in 24 cases. In 85 cases with dysplasia of proximal sacrum, ICD line type I was found in 8 cases, type II in 12 cases and type III in 65 cases. 49 patients (58.8%, 49/85) were able to complete the implantation of S 1 sacroiliac screw, while 36 patients (35.3%, 36/85) were only able to complete the implantation of S 2 sacroiliac screw. The Gras score of postoperative screw position was 90.05% for grade I, 9.94% for grade II, and 0 for grade III. In 1 case the sacroiliac screw pierced through the anterior cortex of the sacrum, and in 1 case the screw partially threaded into the sacral foramen, and there were no symptoms of iatrogenic nerve injury. The R1 values of the preoperative steep sacral alar slope group, the mastoid protrusion group, the sacral foramen oval degeneration group, the lumbar sacralization group, the sacral foramen oval degeneration group and normal development patient group were 11.4±3.0, 11.6±3.2, 9.8±3.0, 8.8±4.2, 6.5±4.4, and 11.4±3.4 mm, respectively. The differences between the lumbar sacralization group, the sacral foramen oval degeneration group, and the S1 anterior cortical depression group with the normal development patients were statistically significant, respectively ( t=-3.05, P=0.005; t=-2.32, P=0.022; t=-3.45, P=0.006). The postoperative angle ∠A of the above six groups were 33.8°±4.2°, 20.8°±3.5°, 25.8°±2.5°, 35.5°±4.5, 27.8°±3.5° and 26.8°±5.0°, respectively. The postoperative angle ∠B of the above six groups were 27.8°±3.5°, 36.2°±3°, 26.3°±1.8°, 29.8°±2.7°, 14.8°±1.5° and 37.2±4.2°, respectively. The differences between the ∠A of the steep sacral alar slope group, the mastoid protrusion group, and tthe lumbar sacralization group with that of the normal development patients were statistically significant, respectively ( t=9.17, -7.48, 7.97, P<0.001). The differences between the ∠B of the steep sacral alar slope group, the lumbar sacralization group, the sacral foramen oval degeneration group, and the S 1 anterior cortical depression group with that of the normal development patients were statistically significant, respectively ( t=-14.68, -10.93, -19.79, -35.8, P<0.001). Conclusion:This study proposes the "absolute stenosis" of the S 1 screw channel; In the treatment of patients with abnormal proximal sacral fracture, attention should be paid to S 1 anterior cortical depression and lumbar sacralization, and robot-assisted sacroiliac screw implantation can further improve the safety and accuracy of sacroiliac screw implantation.

Objective: To explore the relationship between adolescent depressive symptoms, childhood psychological trauma and maternal illness during pregnancy, so as to provide scientific busis for the development of adolescent mental health. Methods: A stratified cluster random sampling method was employed to select 2 092 primary and secondary school students in Wuhan City from January to July 2022. Questionnaires were administered to investigate adolescent depressive symptoms, childhood psychological trauma, and maternal illness during pregnancy. The influencing factors of adolescent depression were analyzed. Results: A total of 139 adolescents reported depressive symptoms. The childhood trauma questionnaire (CTQ) score of the depression group was (57.49± 6.85 ), and the score in adolescents without depression group was (46.28±5.96)( t =21.14, P <0.05). Among the maternal diseases during pregnancy, hypertension accounted for 11.51% , diabetes 9.35%, cholestasis 7.19%, hypothyroidism/hyperthyroidism 7.91% , anemia 9.35% and viral hepatitis 3.60% in depression group, 5.79%, 4.71%, 3.64%, 3.07%, 4.30%, 1.18% in the group without depression, respectively, and the differences were statistically significant ( χ 2=7.35, 5.87, 4.42, 9.28, 7.49, 5.75, P <0.05). The proportion of academic stress in the depressed group and non-depressed group were 61.15% and 46.34%, respectively, and was statistically significant ( χ 2=16.04, P <0.05). Multivariate Logistic regression analysis showed that gestational hypertension ( OR=5.04, 95%CI =2.07-12.24), diabetes mellitus ( OR=4.49, 95%CI =1.85-10.91), anemia ( OR=3.68, 95%CI =1.51-8.94), high academic stress ( OR=3.52, 95%CI =1.45-8.56) and the Childhood Trauma Questionnaire ( OR=4.63, 95%CI = 1.91 -11.26) were the risk factors of depression in adolescents ( P <0.05). Conclusion Adolescent depression may be due to high academic stress, childhood psychological trauma, maternal hypertension, diabetes, thyroid dysfunction and anemia in pregnancy. It is suggested that relevant departments provide appropriate measures to reduce the risk of adolescent depression.

The follow-up treatment of patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation after drug resistance to EGFR-tyrosine kinase inhibitors (TKIs) have become a hotspot and difficulty at present. Immune checkpoint inhibitors (ICIs) therapy is a new and important choice for these patients, but many studies have shown unsatisfactory efficacy. However, some domestic and foreign studies have shown that ICIs combination therapy is still effective in some patients with positive driver genes and drug resistance after targeted therapy. So, in the era of immunotherapy, what are the differences in the efficacy of different combination immunotherapy strategies for different patients? What are the factors that affect efficacy? What are the interrelationships between these factors and other immunotherapy efficacy prediction biomarkers? All these problems have broad and important research value.
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Carcinoma, Non-Small-Cell Lung/genetics* ; Drug Resistance, Neoplasm/genetics* ; ErbB Receptors/metabolism* ; Humans ; Lung Neoplasms/genetics* ; Mutation ; Protein Kinase Inhibitors/therapeutic use*