OBJECTIVE: To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. METHODS: A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups ( P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. RESULTS: Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant ( P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group ( P<0.05), the incision was significantly longer ( P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups ( P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups ( P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups ( P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups ( P<0.05). There was no significant difference between the two plate groups ( P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups ( P>0.05). CONCLUSION For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
Humans ; Femoral Neck Fractures/diagnostic imaging* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Bone Screws ; Adult ; Aged ; Treatment Outcome ; Printing, Three-Dimensional ; Operative Time

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

ObjectiveTo study the effects of Buyang Huanwutang on the skeletal muscle injuries in type 2 diabetes mellitus from mitochondrial transport， glucose metabolism， oxidative stress， and inflammation. MethodA total of 60 SPF-grade male C57BL/6J mice were selected in this study. The mouse model of type 2 diabetes mellitus was established with a high-fat diet combined with intraperitoneal injection of streptozotocin. The mice were assigned by the random number table method into blank control， model， high-， medium-， and low-dose （86.5， 43.2， 21.6 g·kg^-1， respectively） Buyang Huanwutang， and metformin （150 mg·kg^-1） groups， 10 mice in each group. During the experiment period， blood glucose and other indicators of mice were measured regularly. At the end of the experiment， skeletal muscle samples were collected and frozen in 4% paraformaldehyde and -80 ℃， respectively. Blood samples were sent for examination. The skeletal muscle was stained with hematoxylin-eosin. The levels of inflammation indicators and reactive oxygen species （ROS） were determined by enzyme-linked immunosorbent assay. The expression of mitochondrial proteins was determined by Western blot and immunohistochemistry. ResultCompared with the blank control group， the model group showcased increased fasting blood glucose， water intake， and food intake （P<0.01） and decreased body weight （P<0.01）. Compared with the model group， metformin and Buyang Huanwutang reduced the fasting blood glucose， water intake， and food intake （P<0.05， P<0.01） and increased the body weight （P<0.01）. Compared with the blank control group， the model group showed rising levels of tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， and ROS （P<0.01）， which were decreased by metformin and Buyang Huanwutang （P<0.05， P<0.01）. The skeletal muscle fibers in the model group were generally atrophic and thin， which suggested atrophy and morphological changes of the skeletal muscle， while metformin and Buyang Huanwutang alleviated the pathological changes of the skeletal muscle and restored the morphology of fiber bundles. Compared with the blank control group， the modeling down-regulated the expression of the mitofusin2 （Mfn2） （P<0.01）， which was up-regulated by metformin and Buyang Huanwutang （P<0.05， P<0.01）. Compared with the blank control group， the modeling up-regulated the expression of the dynamin-related protein （Drp1） （P<0.01）， which were down-regulated by metformin and Buyang Huanwutang （P<0.01）. ConclusionBuyang Huanwutang can improve the body weight and attenuate the pathological changes of the skeletal muscle， reduce fasting blood glucose， food intake， and water intake， lower the levels of TNF-α， IL-6， and ROS， down-regulate the expression of Drp1， and up-regulate the expression of Mfn2 in the mouse model of type 2 diabetes mellitus.

Objective To systematically evaluate qualitative studies on the experience of transition from adolescent to adult medical care for patients with congenital heart disease(CHD),and to provide a reference for exploring CHD transition management options and developing intervention strategies.Methods A computerized search of PubMed,Embase,Web of Science,Cochrane Library,EBSCO,CINAHL,China Knowledge Network,Wanfang database,Vipshop database,and China Biomedical Literature Database for qualitative studies on the transition experience of CHD patients from adolescence to adult medical care was conducted for the period from the establishment of the database to April 2023.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated using meta-integration methods.Results A total of 9 studies were included,and 49 research results were extracted,and 11 categories were summarized.The final synthesis included 4 integrated results:①Complex attitudes towards healthcare transition,with both attachment and expectation:attachment to paediatric healthcare providers,expectation of transition to adult healthcare providers.(2)Facing multiple healthcare transition challenges:lack of adequate preparation for healthcare transition,parents withdrawing from the role of disease manager,large differences in services between paediatric and adult healthcare providers.③Expect to receive multiple supports:expect to receive comprehensive health education from healthcare personnel,expect healthcare institutions to set up healthcare transition counselling clinics and achieve handover of illness,expect to receive companionship and support from parents,expect to receive understanding and help from peers.④ Per-ceived benefits of medical transition:increased ability to manage illness,role change and personal growth.Conclusion Adolescents with CHD have a complex experience of transitioning to adult healthcare,and healthcare professionals should be attentive to their feelings,encourage them to deal with challenges positively,and provide adequate information and joint parental and peer support to facilitate a smooth transition to adult healthcare for adolescents.

The study presents a method for the personalized biomechanical modeling of the human head and validates the generated model.Based on the TUST 50th percentile head biomechanical model,the method utilizes head CT data of the target model,and employs three-dimensional point cloud registration and free-form deformation techniques to rapidly develop a personalized head finite element model with detailed brain tissue structures.By reconstructing classic cadaver tests,it is found that the personalized head biomechanical model created by the proposed method shows a good consistency with the results of cadaver tests in kinematic and biomechanical responses.Furthermore,no significant differences are observed when compared with the head biomechanical model developed using reverse engineering method,thus verifying the effectiveness of the developed model.Consequently,the proposed method can be used to quickly construct personalized head biomechanical models with detailed anatomical structures,providing a fundamental computational analysis tool for researches in injury biomechanics,clinical medicine,and forensic identification.

Background::The association and its population heterogeneities between low-density lipoprotein cholesterol (LDL-C) and all-cause and cardiovascular mortality remain unknown. We aimed to examine the dose-dependent associations of LDL-C levels with specific types of cardiovascular disease (CVD) mortality and heterogeneities in the associations among different population subgroups.Methods::A total of 2,968,462 participants aged 35-75 years from China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) (2014-2019) were included. Cox proportional hazard models and Fine-Gray subdistribution hazard models were used to estimate associations between LDL-C categories (<70.0, 70.0-99.9, 100.0-129.9 [reference group], 130.0-159.9, 160.0-189.9, and ≥190.0 mg/dL) and all-cause and cause-specific mortality.Results::During a median follow-up of 3.7 years, 57,391 and 23,241 deaths from all-cause and overall CVD were documented. We observed J-shaped associations between LDL-C and death from all-cause, overall CVD, coronary heart disease (CHD), and ischemic stroke, and an L-shaped association between LDL-C and hemorrhagic stroke (HS) mortality ( P for non-linearity <0.001). Compared with the reference group (100.0-129.9 mg/dL), very low LDL-C levels (<70.0 mg/dL) were significantly associated with increased risk of overall CVD (hazard ratio [HR]: 1.10, 95% confidence interval [CI]: 1.06-1.14) and HS mortality (HR: 1.37, 95% CI: 1.29-1.45). Very high LDL-C levels (≥190.0 mg/dL) were associated with increased risk of overall CVD (HR: 1.51, 95% CI: 1.40-1.62) and CHD mortality (HR: 2.08, 95% CI: 1.92-2.24). The stronger associations of very low LDL-C with risk of CVD mortality were observed in individuals with older age, low or normal body mass index, low or moderate 10-year atherosclerotic CVD risk, and those without diagnosed CVD or taking statins. Stronger associations between very high LDL-C levels and all-cause and CVD mortality were observed in younger people. Conclusions::People with very low LDL-C had a higher risk of all-cause, CVD, and HS mortality; those with very high LDL-C had a higher risk of all-cause, CVD, and CHD mortality. On the basis of our findings, comprehensive health assessment is needed to evaluate cardiovascular risk and implement appropriate lipid-lowering therapy for people with very low LDL-C.

Objective:To improve understanding of acute promyelocytic leukemia (APL) with STAT3::RARA fusion gene positive.Methods:The clinical data, gene detection, diagnosis and treatment of 1 APL patient with STAT3::RARA fusion gene positive admitted to General Hospital of Ningxia Medical University in July 2020 were retrospectively analyzed, and the related literatures were reviewed.Results:The patient was a 70-year-old elderly male who was admitted to the hospital due to bleeding hemorrhoids accompanied with recurrent oral ulcers for 2 months. Physical examination showed anemic appearance and no obvious positive signs were detected. Admission blood routine examination: white blood cell count was 4.36×10 9/L, neutrophil ratio was 56.5%, lymphocyte ratio was 22.7%, hemoglobin was 67 g/L, and platelet count was 37.0×10 9/L. Bone marrow smear of ilium puncture: myeloproliferative hyperplasia was hyperactive, granular dysplasia was abnormal and pathological promyelocytes could be predominantly seen. The results of real-time quantitative polymerase chain reaction showed that PML::RARA L (bcr1), PML::RARA V (bcr2) and PML::RARA S (bcr3) were not detected. PML::RARA fusion gene probe fluorescence in situ hybridization showed positive for partial deletion of RARA gene locus and negative for fusion of PML::RARA gene locus. Blood tumor panoramic gene variation test showed STAT3::RARA fusion gene was positive, and no gene variation associated with blood tumors was detected. Finally, the patient was diagnosed as atypical APL (STAT::RARA fusion gene positive). The patient did not respond to the combination treatment of all-trans retinoic acid and arsenic trioxide. And then he received symptomatic supportive treatment rather than the combined chemotherapy, and was discharged after remission of fatigue symptoms. Conclusions:STAT::RARA fusion gene positive APL is clinically rare and lacks effective treatment compared with classical APL. Its insensitivity to all-trans retinoic acid and arsenic trioxide may be related to this fusion gene.

Objective To investigate the injury mechanisms of three-year-old child occupants by reconstructing a real traffic accident.Methods A traffic accident case from the CIREN database was reconstructed using a vehicle finite element model and a three-year-old child occupant injury bionic model(TUST IBMs 3YO-O).The Δv,mass of the vehicle,and deformation energy were comprehensively analyzed to calculate the collision velocity of the vehicle.This accident was simulated to present injuries to a child occupant,and the injury mechanisms were analyzed in depth.Results The TUST IBMs 3YO-O fully reconstructed the injuries of the child occupant in this case.The kinematic and biomechanical responses of the children's heads differed.The biomechanical response of the internal tissues and organs in the chest cavity showed no injury,however,the result ant chest acceleration at 3 ms reached 54 g,which exceeded the threshold.Conclusions In the future,it will be necessary to adopt biomechanical parameters for occupant safety evaluations.The application of human biomechanical models with high biofidelity to reconstruct occupant injuries in traffic accidents can not only be used to observe the kinematic responses of the occupant in the accident and analyze the injury mechanisms in depth,but also to provide references for virtual testing,as well as for the research and development of child occupant protection devices and the formulation of safety regulations.

Objective:To study the growth trajectory and the incidence of malnutrition and clinical events in infants with congenital heart disease in 1 year after surgery.Methods:Children at the age of 1 year or younger who were diagnosed with congenital heart disease and underwent surgery at Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University from January 2018 to January 2019 were included. The age, gender, birth weight and length, and parental height and weight were collected, and the occurrence of clinical events of interest and the children's health as evaluated by caregiver within 1 year after surgery were followed up through questionnaire survey. Malnutrition was defined as a weight-for-age z-score (WAZ) ≤-2 at 1 year after surgery and a WAZ>-2 was defined as non-malnourished.Results:Among the 502 children, 301 were boys and 201 were girls, aged 4.1 (range: 2.0 to 6.8) months, of whom 64.7% were with simple congenital heart disease and 35.3% complex congenital heart disease. The children were generally with mild malnutrition (WAZ<-1 and >-2) before surgery. At 3 months and 6 months after surgery, the children showed a rapid growth catch-up, although failing to reach the normal level, and the trend plateaued at 1 year after surgery. The proportion of children with malnutrition decreased gradually within 1 year after surgery. 47.0% of included children had malnutrition before surgery, and the proportion decreased significantly at 3 months and 6 months, to 17.9% at 1 year after surgery. After discharge, these children suffered from upper respiratory infection most commonly (74.5%), followed by pneumonia (41.2%) and diarrhea (36.7%), and vomiting and constipation (22.1%). In terms of children's health status as evaluated by parents, about 32.0% of families considered their children in poor health before surgery, and the proportion decreased to 6.9% within 1 year after surgery.Conclusion:Infants with congenital heart disease continued to grow and catch up within 1 year after surgery, showing significantly improved nutrition status, but some children still experienced malnutrition at 1 year after surgery.