Objective To explore the clinical characteristics, treatment and prognostic factors of cardiogenic shock in children. Methods A retrospective analysis was done on clinical features,management strategies and outcome in 36 children with cardiogenic shock in Intensive Care Unit of our hospital from February 1994 to December 2005. Results The clinical presentations of 36 patients varied with the different ages and different primary diseases. And the duration between the presentation and the onset of shock varied with the different primary diseases: the duration for paroxysmal supraventricular tachycardia (PST) was (62.2?12.9) hours, cardiomyopathy (CMP) was (42.0?23.0) hours, endocardial fibroelastosis (ECF) was (20.3?11.1) hours, and fulminant myocarditis (FMC) was (15.0?7.8) hours. At the early stage of shock, all patients showed soft heart sounds.Gallop rhythm was found in 15 cases (41.6%)and cardiopulmonary resuscitation was needed in 17 cases (47.2%).All cases had decreased ejection fraction(EF) and fractional shortening(FS) [(0.32?0.11), (0.14?0.05),respectively] on echocardiography.Cardiothoracic ratio increased in 35 cases (97.2%) and arrhythmia developed in 34 cases (94.4%). The duration from initial treatment to shock correction of was related to the prognosis (P=0.002, Wald=9.91).Fluid resuscitation in cardiogenic shock needed close monitor, and the amount of fluid was 5.25 ml?kg -1?h -1,4.48 ml?kg -1?h -1,4.75 ml?kg -1?h -1 in ECF,FMC and CMP,respectively. Conclusion The clinical presentations high in cardiogenic shock in children were various. Early bedside echocardiogram, chest X-ray and electrocardiogram would be helpful in diagnosis. The duration from initial treatment to shock correction was a strong prognostic factor for cardiogenic shock. Compared with other kinds of shock, fluid resuscitation had its features.

ObjectiveTo investigate the effect of anti-liver fibrosis Chinese patent drugs on renal hypofunction associated with alcoholic liver disease (ALD). MethodsA retrospective analysis was performed for 592 patients with ALD who were admitted to Beijing Ditan Hospital, Capital Medical University, from August 1, 2008 to March 1, 2016, and according to whether they were treated with Fuzheng Huayu capsules, Anluo Huaxian pills, or Fufang Biejia Ruangan tablets for ≥180 cumulative defined daily doses, they were divided into Chinese medicine group and control group. After propensity score matching at a ratio of 1∶1, two groups were obtained with 187 patients in each group. Related data were recorded, including medical history, drinking amount, routine blood test results, liver and renal function, coagulation, and abdominal imaging findings. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to compare the cumulative incidence rate of renal hypofunction between two groups. ResultsThere were no significant differences between the two groups in age, drinking amount, proportion of patients with hypertension or diabetes, baseline aspartate aminotransferase, estimated glomerular filtration rate, uric acid, and prothrombin time, and the patients were followed up for 36 months (range 23-54 months). Uric acid (hazard ratio ［HR］=1.003, 95% confidence interval ［CI］: 1001-1.005, P=0.001), prothrombin time (HR=1.103, 95%CI: 1.034-1.177, P=0.003), and red cell volume distribution width (HR=1.024, 95%CI: 1.011-1.038, P＜0.001) were independent risk factors for renal hypofunction in patients with ALD, and anti-liver fibrosis Chinese patent drug was an independent protective factor against renal hypofunction (HR=0.170, 95%CI: 0.053-0552, P=0.003). The Chinese medicine group had a significantly lower incidence rate of renal hypofunction than the control group (166% vs 32.1%, χ2=10.263, P=0.001). The subgroup analysis of the patients in the Chinese medicine group showed that Chinese medicine treatment for ＞24 months had the best effect (HR=0.210, 95%CI: 0.084-0.525, P=0.001). Compared with the control group, the Chinese medicine group had a significantly longer time to the onset of renal hypofunction (36 months vs 24 months, Z=-2.652, P=0.008). ConclusionAnti-liver fibrosis Chinese patent drugs can reduce the incidence rate and delay the onset of renal hypofunction in patients with ALD.

Objective To explore the CTV to PTV external expansion boundary and the effect of the dose of normal lung tissue under different fixed modes by a comparative analysis of combined body position and thermoplastic film fixed set-up error of radiation therapy for lung cancer. Methods From October 2016 to March 2018, the patients who received chest radiology at the Tangshan people's hospital were enrolled as subjects retrospectively divided into two groups, including 50 patients with lung cancer radiotherapy with combined body position fixation, and 40 patients with lung cancer with thermoplastic film fixation. The two groups of patients drew the target areas in accordance with the unified standard, and the set-up error of left and right, up and down, front and rear ( x, y, z axis) were recorded respectively after 1 time/week cone CT( CBCT) matched with the planned CT image and analyzed by t test. According to the MPTV =2. 5Σ+0. 7δ, CTV to PTV external expansion boundary in the combined body position group were calculated. And the V5、V20 and V30 of two groups of patients were calculated and analyzed by TPS system. Results The set-up error of the combined body position group and thermoplastic film group were respectively (1. 00 ± 0. 58) mm and (3. 28 ± 0. 43) mm on the x axis, (1. 42 ± 0. 28) mm on the y axis and (4. 03 ± 0. 41) mm, (1. 06 ± 0. 44) mm and (3. 18 ± 0. 34) mm on the z axis. The set-up errors of the two groups were statistically significant on x, y and z axis( t= -20. 740, -35. 596, -25. 015,P<0. 05). There was no significant difference in set-up errors between the central and peripheral lung cancer patients and between left and right lung cancer patients(P>0. 05). Through the MPTV =2. 5Σ+0. 7δ, CTV to PTV external expansion boundary in the combined body position fixation group was 2. 906 , 3. 746 and 2. 958 mm on x, y and z axis respectively. The comparison between group A and B showed that the mean values of V5 , V20 and V30 in group B were reduced by 1. 5％, 3. 1％ and 4. 8％ respectively compared with group A. Conclusions The combined body position technique can improve the accuracy of lung cancer patients after radiation therapy,and further reduce the boundary of CTV to PTV, which is of certain value to reduce the occurrence of radiation pneumonitis.

Objective:To investigate the efficacy of elastic locking intramedullary nail (ELIN) in the treatment of mid clavicle fractures.Methods:From January 2014 to December 2020, the data of 61 patients with mid-clavicle fracture treated with ELIN were retrospectively analyzed. Among them, 38 patients were from the Fourth Central Hospital Affiliated to Nankai University and 23 were from the Second People's Hospital of Hulunbuir City. There were 36 males and 25 females, aged from 19 to 85 years (average, 54.5 years), 39 cases on the left side and 22 cases on the right side. According to Robinson's classification, there were 20 cases of type 2A2, 29 cases of type 2B1 and 12 cases of type 2B2. There was no nerve or vascular injury before operation. The postoperative evaluation measures included incision length, operation time, blood loss, fracture reduction, fracture healing time, ELIN removal time, shoulder Constant-Murley score, disabilities of the arm, shoulder, and hand (DASH) score, and related complications.Results:All patients were followed up for 13-51 weeks (average, 21.8 weeks). There were 34 cases of closed reduction and 27 cases of mini-open reduction, and the length of incision was 2.04±1.08 cm. The closed reduction operation time was 20.32±7.11 min, and the mini-open reduction operation time was 20.30±5.37 min. The intraoperative blood loss was 6.47±2.31 ml in the closed reduction group and 27.41±11.55 ml in the mini-open reduction group. Compared with the healthy side, the clavicle length of the affected side was shortened by 7.74%±3.51% of pre-operation and 0.71%±1.00% of post-operation, there was statistically significant difference in the length of clavicle shortening of pre- and post-operation ( t=3.84, P<0.001). The fracture healing time was 10.48±2.39 weeks. The removal time of ELIN was 13.39±2.69 weeks. At the last follow-up, the Constant-Murley score of shoulder joint was 98.87±1.74. The average of DASH score was 1.13 (range, 0-10). There were 18 cases of skin irritation after operation, of which 13 cases formed pressure sores at the tail end 3-6 weeks after the operation, and were treated with dressing change and keeping clean; 4 cases of skin irritation at the tail end formed bursitis, which disappeared after removal of the internal fixation. In 1 case, the tip of ELIN penetrated the anterior cortex from the proximal clavicle and stimulated the skin. Radiograms showed continuous callus at 4 weeks after operation, and there was no local tenderness on the physical examination, which reached the clinical healing standard, and the symptoms were relieved after the nail was removed. No serious complications such as neural and vascular injury, nail breaking, delayed healing, infection, numbness or discomfort in the subclavian area occurred in all cases, and all patients were satisfied or basically satisfied with the aesthetic of the skin appearance. Conclusion:Minimally invasive and microstress shielding fixation of mid-clavicle fracture with ELIN have the advantages of simple operation, minimally invasive, beautiful appearance, anti-short-shrinkage and rapid fracture healing etc. It is an effective surgical method for the treatment of mid-clavicle fractures.

Objective:To compare the efficacy of double thread elastic locking intramedullary nail (ELIN) and threaded elastic intramedullary nail (TEIN) in the treatment of mid-shaft clavicular fracture.Methods:From August 2017 to September 2020, 33 patients with mid-shaft clavicular fractures were treated with ELIN (double threaded nail group), including 14 males and 19 females, age 52.09±16.32 years old; Robinson classification: 20 cases of type 2A2, 6 cases of type 2B1, and 7 cases of type 2B2. Thirty-two patients were selected as the control group with TEIN fixation (single threaded nail group) during the same period, including 13 males and 19 females; age 43.25±15.03 years old; Robinson classification: 19 cases of type 2A2 and 5 cases of type 2B1, 8 cases of 2B2 type. The operation time, intraoperative incision length, fracture healing time, internal fixation removal time, Constant-Murley shoulder joint score, disabilities of the arm, shoulder, and hand (DASH) score, fracture reduction and postoperative complications were compared between the two groups.Results:The patients in both groups were followed up after operation, the double-threaded screw group was followed up for 16-48 weeks (average, 23.7 weeks), and the single threaded nail group was followed up for 15-51 weeks (average, 22.9 weeks). The operation time of the double threaded nail group and the single threaded nail group were 19.45±6.74 min and 19.59±4.98 min, and the length of the incision was 1.70±0.79 cm and 1.73±0.84 cm. The fracture healing time were 12.12±1.29 weeks and 13.88±1.84 weeks. The internal fixation removal time was 13.09±1.31 weeks and 15.69±1.94 weeks. The Constant-Murley shoulder score was 93.18±3.78 points and 90.09±4.03 points, and the DASH scores were 1.49± 0.49 points and 3.85±1.13 points; There was no significant difference in operation time and incision length between the two groups ( t=0.01, 0.19; P>0.05), while fracture healing ( t=3.70, P<0.001), internal fixation removal time ( t=6.34, P<0.001), Constant-Murley shoulder score ( t=3.19, P<0.001), DASH score ( t=10.95, P<0.001) differences were statistically significant. The length of the clavicle on the healthy side was 16.38±1.09 cm in the double threaded nail group, and the length of the clavicle on the affected side after internal fixation removal was 16.33±1.12 cm. There was no obvious shortening deformity on the affected side, and there was no significant difference in the length of the clavicle between the two sides ( t=1.57, P=0.127). The clavicle lengths of the healthy side and the affected side after internal fixation removal in the single threaded nail group were 16.55±1.12 cm and 15.12±1.18 cm, and the difference was statistically significant ( t=8.02, P<0.001). The postoperative shortening values of the double-threaded screw group and the single-threaded screw group were 9.47±2.12 mm and 17.41±2.42 mm, and the difference was statistically significant ( t=14.07, P<0.001). Postoperatively, 5 cases of bursitis and 2 cases of skin irritation occurred in the double threaded nail group; While 6 cases of bursitis, 3 cases of skin irritation, 4 cases of shortening malunion, and 1 case of broken nail occurred in the single threaded nail group (fracture delayed union after replacement of internal fixation); the other patients did not experience screw retraction, wound infection, delayed fracture union or nonunion, neurovascular injury, and achieved osseous union. Conclusion:Both elastic intramedullary nails are effective surgical methods for the treatment of middle clavicle fractures, and the operation time is short and minimally invasive. However, compared with the TEIN, the fracture healing time of the double-threaded ELIN is shorter, the internal fixation removal time is earlier, the shoulder joint and upper limb function is better, and the shortening deformity is less likely to occur.

Objective:To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures.Methods:A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years; 16 left and 15 right sides; 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years; 13 left and 13 right sides; 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] ( P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference ( P>0.05). Conclusion:Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.

Silicosis is a leading cause of occupational disease-related morbidity and mortality worldwide, but the molecular basis underlying its development remains unclear. An accumulating body of evidence supports gasdermin D (GSDMD)-mediated pyroptosis as a key component in the development of various pulmonary diseases. However, there is little experimental evidence connecting silicosis and GSDMD-driven pyroptosis. In this work, we investigated the role of GSDMD-mediated pyroptosis in silicosis. Single-cell RNA sequencing of healthy and silicosis human and murine lung tissues indicated that GSDMD-induced pyroptosis in macrophages was relevant to silicosis progression. Through microscopy we then observed morphological alterations of pyroptosis in macrophages treated with silica. Measurement of interleukin-1β release, lactic dehydrogenase activity, and real-time propidium iodide staining further revealed that silica induced pyroptosis of macrophages. Additionally, we verified that both canonical (caspase-1-mediated) and non-canonical (caspase-4/5/11-mediated) signaling pathways mediated silica-induced pyroptosis activation, in vivo and in vitro. Notably, Gsdmd knockout mice exhibited dramatically alleviated silicosis phenotypes, which highlighted the pivotal role of pyroptosis in this disease. Taken together, our results demonstrated that macrophages underwent GSDMD-dependent pyroptosis in silicosis and inhibition of this process could serve as a viable clinical strategy for mitigating silicosis.