BACKGROUND:StageIorIIKummel’s diseaseisusualy suggested to be treated with percutaneous vertebroplasty (PVP) orpercutaneous kyphoplasty (PKP). Stage IIIKummel’s diseasewith neurologic deficit is treated with open decompression, cement-augmented combined with internalfixation. However, surgical options for stage IIIKummel’s diseasewithdural saccompression butwithnonervous symptoms arein disputeand rarely reported. OBJECTIVE:To investigatethesurgical options of Kummel’s disease with vertebral posterior walcolapse. METHODS:Fourteen patients with Kummel’s disease with vertebral posterior wal colapse wereenroled as experimental groupandtreated with PVP or PKP based on the degree of postural reduction.Another28 patients with osteoporotic vertebral fracture as control group were treated with PKP. Thenalpatients were folowed up to observe vertebralheight, Cobb angle, visual analog scale and the Oswestry disability index. RESULTS AND CONCLUSION:After folowed up for 10 to 42 months, therestoredvertebralheight, Cobb angle, visual analog scale and Oswestry disability index were significantly improved inthetwo groups (P<0.05). Thepostoperativevertebralheight intheexperimental group was significantly higher than thatinthe control group(P< 0.05).Butno significant differencesin Cobb angle, visual analog scalescoresand Oswestry disability indexwere found between thetwo groups after operation (P> 0.05). These data suggest that based on the degree of postural reduction, individualizedPVP or PKP for Kummel’s disease with vertebral posterior wal colapsecanattain satisfactoryoutcomes.

The contents of reduced and total ascorbic acid, vitamins P, reducing and total sugar, citric acid, ash, calcium, crude fibre and moisture in the edible portions of 23 main varieties of Chinese oranges and tangerines have been determined. The change of ascorbic acid content of the fruits during storage has also been investigated.Ascorbic acid content of orange is higher than that of tangerine. Oranges contain 46.6-62.3mg% of reduced ascorbic acid and 48.8-72.4mg% of total ascorbic acid and tangerines contain 14.3-48.7rng% and 19.5-50.7mg% respectively.Locality affects the composition of fruits: fruits grown in Fukien and Kwangtung provinces generally contain more ascorbic acid and .sugar, and less citric acid and calcium than those grown in Kianghsi and Chekiang.Five strains of fruits have been subjected for storage test. The loss of ascorbic acid in the fruits during 2-3 months storage in the winter season ranged 0-40% of the original content. No loss of ascorbic acid has been observed in Hsuehkan (雪柑), after 3 months storage at -2? to 4℃, but loss of 40% of the reduced and 20% of the total ascorbic acid content occurred in Kwangtung chiaokan (广东蕉柑) after two and half months storage muler -1? to 12℃

Objective To study the changes of bone mineral density (BMD) and structural parameters of femoral neck in fragile femoral neckfracture,and to investigate the relationship between the changes and occurrence of fragile fracture of femoral neck.Methods 102 patients were divided into fracture group (n=59) and non-fracture group (n=43).There were 18 males and 41 females [[mean age (74.0±9.3) yrs,ranged 53-88 yrs] in fracture group and 16 males and 27 females [mean age (64.3±9.9)] yrs,ranged 50-82 yrs in non-fracture group.CT scan and BMD in the femoral neck were collected in all patients.The structural parameters of the femoral neck in CT scan were measured with medical image analysis software.Results BMD was lower,cortical thickness of femoral neck (FNCT) was thinner and the ratio (FNCT/FNW) of cortical thickness (FNCT) over femoral neck width (FNW) was lower in fracture group than in non-fracture group (all P＜0.001),but there were no statistically significant differences in femoral neck width (FNW) and femoral medullary cavity width (FMCW) between the two groups (both P＞0.05).The BMD of femoral neck was markedly decreased in the fracture group as compared with the non-fracture group in patients aged 50-64 yrs (P ＜0.05),and there were no statistically significant differences in the changes of the femoral neck BMD between the two groups in patients aged over 65 yrs (P＜0.05).In both of patients aged 50-64 yrs and more than 65 yrs,FNCT was thinner and ratio of FNCT/FNW was lower in the fracture group than in the non-fracture group (both P＜0.05).The patients with osteopenia and osteoporosis had thinner FNCT and lower ratio of FNCT/FNW in the fracture group than in the non-fracture group of the patients with osteopenia and osteoporosis (both P＜ 0.01).Conclusions Lower BMD and thinner cortical thickness of femoral neck are closely related to the fragile fracture of femoral neck.The phase of femoral neck BMD rapid decline is mainly in the age of 50-65 yrs,which is consistent with the risk assessment for fragile fracture in femoral neck.The decrease of cortical thickness of femoral neck on FNCT is the main factor for the decreased femoral neck strength in patients aged over 65 yrs,which is also an important factor for the fragile fracture of femoral neck in the elderly aged over 65 yrs.

BACKGROUND:The prevalence of osteoporosis is high in the patients undergoing total hip arthroplasty. Osteoporosis is associated with the survival of prostheses. Both canal flare index and bone mineral density are aged-related.
OBJECTIVE:To study the cxorrelation between canal flare index of the proximal femur and bone mineral density of femoral neck, and to pay more attention to osteoporosis.
METHODS:A retrospective study of the correlation between canal flare index of the proximal femur on pelvic radiograph and bone mineral density of femoral neck was made in 57 patients undergoing total hip arthroplasty.
RESULTS AND CONCLUSION:The canal flare index were ranged 1.8-4.8 (3.1±0.7) in 57 patients. There were 23 patients in canal flare index<3 (chimney-type medul ary cavity), 33 in canal flare index between 3 and 4.7 (normal-type medul ary cavity), and one in canal flare index>4.7 (funnel-type medul ary cavity). The age had an impact on the type of medul ary cavity. The prevalence of chimney-type medul ary cavity were significantly higher in>60 years old group than≤60 years old group, and bone mineral density of femoral neck in the group of canal flare index≥3 was significantly higher than the group of canal flare index<3. The bone mineral density of femoral neck was gradual y reduced with age, and were significantly higher in≤60 years old group than in>60 years old group [(0.751±0.235) g/cm2, (0.590±0.092) g/cm2, P=0.000]. As bone mineral density reduced, canal flare index was also decreased. Experimental findings indicate that, the bone mineral density of femoral neck is significantly correlated with canal flare index.

Objective To investigate the feasibility of T2 mapping in evaluating the composition of shoulder cartilage,and to quantitatively analyze T2 values of articular cartilage in healthy young volunteers.Methods Oblique coronal T2 mapping imaging with 8 echo was performed in bilateral shoulder of 16 young healthy volunteers.The pseudo-color map was obtained with post-processing.The shoulder joint cartilage was equally divided into the external,central and internal zones,and T2 values were measured quantitatively.T2 values in the external,central and internal zones were analyzed and compared.T2 values of cartilage between male and female volunteers as well as between left and right sides were analyzed.Resuits T2 values in the external,central and internal zones of cartilage were (38.67 ± 2.82)ms,(38.41 ± 2.52)ms and (36.49± 1.80)ms,respectively.The overall difference was statistically significant (F=7.789,P=0.001).T2 values in the external and central zones of cartilage were larger than those in the internal zone (both P＜0.05).T2 values of cartilagehad no significant differences between the left and right sides in the external,central and internal zones (all P＞0.05).There was significant difference of T2 value in the central zone (P＜0.05),while no significant difference of T2 value in the external and internal zones between different genders was found (both P＞0.05).Conclusion T2 mapping imaging can be used to evaluate the composition of shoulder cartilage changes.

Objective To construct N6-methyladenosine related long non-coding RNA(LncRNA)pairing model for renal cell carcinoma based on bioinformatics analysis of the cancer ganome atlas(TCGA)database and to explore its prognosis value.Methods Transcriptome data of RNA-sep for renal cell carcinoma and its related clinical information were downloaded from the TCGA database.Perl software was used to organize and separate LncRNA and messenger RNA(mRNA)from the transcriptome data.A total of 564 tissues from renal cell carcinoma cases and 72 normal tissues were obtained,and thus 540 renal cancer patients were eventually included.Random data table method was used to divide 540 patients with renal cancer into a training group(n=275)and a validation group(n=265)by caret.M6A related LncRNA pairing models were established based on the single factor and multivariate COX regression analysis.The risk assessment equation was obtained using the LASSO regression algorithm.The risk scores were calculated based on this equation,and the optimal critical point of the median risk value was applied to divide all patients into high-risk and low-risk groups.Kaplan-Meier survival analysis was used to make a survival curve for the differences between high and low risk groups in the overall sample.The gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analyses were conducted using the Cluster Profiler software package.The relationship between N6-methyladenosine related LncRNA pairing model and immune cell infiltration was analyzed by R software.Results Kaplan-Meier survival analysis showed the total survival time of patients in the low-risk group was significantly higher than that of patients in the high-risk group of the training group(P<0.05).Compared with high risk group,the overall survival time of patients(G1～2,G3～4,Ⅰ～Ⅱ,or Ⅲ～Ⅳ,age≤65 years,or patients>65 years old)in low risk group was higher(P<0.05).Differential gene enrichment analysis was obtained for high and low risk groups,which mainly enriched with many differential genes such as muscle contraction,rhabdomytic cell differentiation,myofibril,receptor activation activity,and vascular smooth muscle contraction.The highest driver genes in high risk group and low risk group exhibited mutation frequency and mutation information,and their risk score was positively correlated with the degree of T cell and plasma cell infiltration(r=0.638,P=0.001).Conclusion Bioinformatics-based analysis of the N6-methyladenosine related LncRNA pairing models can be helpful to predict the prognosis of patients with renal cancer.It provides new ideas for the prognosis evaluation and optimal treatment strategy of renal cancer,and contributes to further analyzing the molecular mechanism of the occurrence and development of gastric cancer in the future.

Objective To explore the mechanisms of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) in improvement of renal injury in rats with diabetic nephropathy (DN) by regulating mammalian target of rapamycin (mTOR)/p70 ribosome protein S6 kinase (S6K1)/coiled-coil myosin-like Bcl-2-interacting protein (Beclin 1) pathway. Methods The model of SD rats with DN was established by a method of high-fat diet combined with intraperitoneal injection of streptozotocin, and they were randomly divided into model group, MSC-EVs group, and MSC-EVs+MHY1485 (mTOR activator) group, with 12 rats in each group. Another 12 SD rats were normally fed for 6 weeks and then intraperitoneally injected with an equal dose of sodium citrate solution as controls. After grouping with MSC-EVs and MHY1485, blood glucose and levels of renal function indicators [blood urea nitrogen (BUN), serum creatinine (Scr), and urinary microalbumin (UmALB)] in rats were detected. HE staining was used to detect the pathological morphology of renal tissue in rats of each group; immunohistochemistry was used to detect the expression of mTOR/S6K1/Beclin 1 pathway related proteins in the renal tissues of rats in each group; the Western blot was used to detect the mTOR/S6K1/Beclin 1 pathway and autophagy-related protein expression in the renal tissues of rats in each group. Results Compared with the control group, the renal tissue morphology of rats in the model group were impaired, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, p-mTOR/mTOR, p-S6K1/S6K1 increased significantly (P < 0.05), while microtubule associated protein 1A/1B light chain 3 (LC3) Ⅱ/LC3Ⅰ, expression of Beclin 1 protein, and relative positive expression of Beclin 1 significantly reduced (P < 0.05); compared with the model group, the MSC-EVs group had less impairment in the renal tissue morphology, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, p-mTOR/mTOR, and p-S6K1/S6K1 decreased significantly (P < 0.05), while expression of LC3Ⅱ/LC3Ⅰ, Beclin 1 protein, and relative positive expression of Beclin 1 increased significantly (P < 0.05); compared with the MSC-EVs group, the impairment of the renal tissue morphology was worse in the MSC-EVs+MHY1485 group, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, expression of p-mTOR/mTOR, and p-S6K1/S6K1 increased significantly (P < 0.05), while the expression of LC3Ⅱ/LC3Ⅰ, Beclin 1 protein, and relative positive expression of Beclin 1 decreased significantly (P < 0.05). Conclusion MSC-EVs can enhance autophagy, reduce levels of blood glucose, Scr, BUN and urinary protein in rats with DN, alleviate renal tissue damage, and the mechanism may be achieved by inhibiting the activation of the mTOR/S6K1/Beclin 1 pathway.

Background: Cervical cancer is still present a major public health problem, especially in developing countries. In International Federation of Gynaecology and Obstetrics 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopical positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. However, there are no prospective study reporting that resecting macroscopic nodes before concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer and no guidelines for surgical resection of bulky lymph nodes. The CQGOG0103 study is a prospective, multicenter and randomized controlled trial (RCT) evaluating lymph node dissection on stage IIICr of cervical cancer. Methods Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by computed tomography [CT]/magnetic resonance imaging/positron emission tomography/CT) and the short diameter of image-positive lymph node ≥15 mm. 452 patients will be equally randomized to receive either CCRT (pelvic external-beam radiotherapy [EBRT]/extended-field EBRT + cisplatin [40 mg/m2] or carboplatin [the area under curve=2] every week for 5 cycles + brachytherapy) or open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. A total of 452 patients will be enrolled from multiple hospitals in China within 4 years and followed up for 5 years.

Objective:To compare the efficacy between Kirschner wire and clavicular hook plate in the fixation of distal clavicle fractures in older children.Methods:A retrospective analysis was conducted of the 28 pediatric patients with distal clavicle fracture who had undergone surgical treatment at Department of Pediatric Orthopedics, The Second General Hospital of Fuzhou from December 2014 to December 2023. There were 20 boys and 8 girls. Age: 10.0 (9.0, 12.8) years old; 22 left sides and 6 right sides; by the Craig modified Neer classification: 22 cases of type Ⅱ, 5 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were divided into 2 groups based on their internal fixation methods. The Kirschner wire group of 12 cases were treated with open reduction and Kirschner wire fixation; the hook plate group of 16 cases were treated with open reduction and clavicular hook plate fixation. Operation time, hospital stay, fracture healing time, incidence of complications, and scores at the final follow-up (the Constant-Murley shoulder function score, quick disabilities of the arm, shoulder, and hand (quickDASH) score, and visual analog scale (VAS) for aesthetic satisfaction) were recorded and compared between the 2 groups.Results:There were no statistically significant differences in the baseline data between the 2 groups, indicating comparability ( P>0.05). The postoperative follow-up period for the 28 patients was (14.8±6.5) months. The operation time in the Kirschner wire group [(34.3±12.1) min] was significantly shorter than that in the hook plate group [(49.4±16.8) min] ( P<0.05), and the VAS score for aesthetic satisfaction at the final follow-up in the Kirschner wire group [(8.2±1.1) points] was significantly higher than that in the hook plate group [(6.2±2.6) points] ( P<0.05). There were no statistically significant differences between the 2 groups in terms of fracture healing time, hospital stay, incidence of complications, or Constant-Murley score and quickDASH score at the final follow-up ( P>0.05). Conclusions:For pediatric patients with distal clavicle fracture, both Kirschner wire fixation and clavicular hook plate fixation can achieve good functional outcomes. However, Kirschner wire fixation has advantages of shorter operation time, higher postoperative aesthetic satisfaction, and no need of a secondary surgery for implant removal.

Objective:To investigate the effects of hyperuricemia on the prognosis of IgA nephropathy (IgAN) using propensity score matching (PSM) method.Methods:IgAN patients proven by biopsy were included. PSM was used to match patients. Kaplan-Meier method was used for survival analysis, and Cox regression analysis was used to analyze the effects of hyperuricemia on IgAN prognosis. Primary outcome events were defined as death, or end-stage renal disease (dialysis, transplantation), or a decrease in estimated glomerular filtration rate (eGFR) greater than 40%. Renal outcome was defined as end-stage renal disease (dialysis, transplantation), or a decrease in eGFR greater than 40%.Results:A total of 1 454 IgAN patients were included in this study, including 850 females and 604 males. Uric acid level was (368.26±92.87) μmol/L in the males, and (277.23±92.71) μmol/L in the females. The median follow-up time was 85.00(56.10, 106.33) months. During the follow-up period, a total of 134 patients reached the primary outcome events, including 5 deaths, 24 dialysis patients, 5 kidney transplant patients, and 100 patients with eGFR decreased by more than 40%. After 1∶1 matching, 131 males and 159 females in the hyperuricemia group were successfully matched with 131 males and 159 females in the normal uric acid group, and there was no significant statistical difference in each parameter in baseline between the hyperuricemia group and normal uric acid group after matching. Kaplan-Meier survival analysis showed that either before or after matching, the incidence of primary outcome events in male or female patients with hyperuricemia was higher than those with normal uric acid, but there was no statistically significant difference in incidence of primary outcome events between female hyperuricemia group and female normal uric acid group after matching (Log-rank test, χ2=3.586, P=0.058). Cox proportional hazard regression model showed that, in the pre-match fully adjusted model, the hazard ratio ( HR) of entering primary outcome events was 2.29-fold (95% CI 1.27-4.11, P=0.006) for men with hyperuricemia and 1.85-fold (95% CI 1.01-3.37, P=0.045) for women with hyperuricemia compared with those with normal uric acid. In the post-match fully adjusted model, the HR of entering primary outcome events was 2.41-fold (95% CI 1.18-4.93, P=0.016) for men with hyperuricemia and 1.83-fold (95% CI 0.91-3.67, P=0.091) for women with hyperuricemia compared with those with normal uric acid. In the pre-match fully adjusted model, the HR of entering renal outcome events was 2.68-fold (95% CI 1.47-4.88, P=0.001) for men with hyperuricemia and 1.81-fold (95% CI 0.99-3.33, P=0.056) for women with hyperuricemia compared with those with normal uric acid. In the post-match fully adjusted model, the HR of entering renal outcome events was 2.89-fold (95% CI 1.36-6.15, P=0.006) for men with hyperuricemia and 1.81-fold (95% CI 0.88-3.72, P=0.106) for women with hyperuricemia compared with those with normal uric acid. Conclusion:Hyperuricemia may be associated with IgAN progression, and it has a more significant effect on male IgAN patients.