OBJECTIVE: To evaluate the effectiveness of minimally invasive reduction and ulna bicortical angulation intramedullary fixation in the management of Bado typeⅠMonteggia fracture in pediatric patients. METHODS: Between August 2018 and August 2020, the clinical data of 15 pediatric patients diagnosed with Bado typeⅠfresh Monteggia fracture were retrospectively analyzed. There were 11 males and 4 females. The left side was implicated in 5 cases, while the right side was involved in 10 cases. The age ranged from 4 to 12 years old. There were a total of 10 cases of upper ulna fractures and 5 cases of middle ulna fractures. Among these, the ulnar fracture line presented as transverse or short oblique in 9 cases, and long oblique or spiral in 6 cases. The pediatric patients underwent treatment utilizing minimally invasive reduction and ulna bicortical angulation intramedullary fixation. The effectiveness of the treatment was assessed based on the Mayo elbow scoring system. RESULTS: The follow-up period for all 15 cases ranged from 6 to 24 months. Among them, the occurrence of needle tail irritation was observed in 3 cases, all of which exhibited satisfactory healing following routine disinfection and dressing change. The other children had no re dislocation of the radial capitulum, no epiphyseal injury, no osteofascial compartment syndrome, elbow instability and other complications. The degree of limitation of daily life, range of motion of joints, pain level and appearance of limbs were recorded at the last follow-up. According to Mayo elbow scoring system, 12 cases were excellent and 3 cases were good. CONCLUSION The minimally invasive reduction and ulna bicortical angulation intramedullary fixation technique is a simple and effective treatment for Bado typeⅠfresh Monteggia fractures in children.
Humans ; Male ; Female ; Child ; Monteggia's Fracture/surgery* ; Child, Preschool ; Minimally Invasive Surgical Procedures/methods* ; Fracture Fixation, Intramedullary/methods* ; Retrospective Studies

OBJECTIVE: To investigate the clinical efficacy and safety of ultrasound-guided closed reduction and internal fixation using Kirschner wire for the treatment of olecranon fractures of the ulna in children. METHODS: Between January 2019 and January 2021, 13 children with olecranon fracture were treated with ultrasound-guided closed reduction and percutaneous Kirschner wire internal fixation, including 10 males and 3 females. The age ranged from 3 to 14 years old. Children with ulnar olecranon fractures were evaluated using the Gicquel scoring system. The clinical evaluation encompassed postoperative pain, functional status, and range of motion, with a maximum score of 15 points. The radiological assessment contributed an additional 4 points. A cumulative score of more than 18 scores was classified as excellent, more than 17 scores as good, more than16 scores as fair, and less than 16 scores as poor. Clinical assessment:A score of 14 indicates excellent performance, a score of 13 reflects good performance, a score of 12 denotes fair performance, and a score of less than 11 signifies poor performance. RESULTS: A total of 13 patients were followed up, with a duration ranging from 6 to 12 months. According to the Gicquel scoring criteria, the comprehensive evaluation of clinical and radiographic findings yielded 10 excellent and 3 good outcomes. Evaluation based solely on clinical findings resulted in 13 excellent outcomes. CONCLUSION Ultrasound-guided percutaneous cross Kirschner wire fixation for children's olecranon fracture has the advantages of less trauma, rapid recovery, less fluoroscopy, and good recovery of elbow function. The clinical effect is satisfactory.
Humans ; Child ; Male ; Female ; Fracture Fixation, Internal/instrumentation* ; Ulna Fractures/physiopathology* ; Bone Wires ; Child, Preschool ; Adolescent ; Olecranon Process/surgery* ; Ultrasonography ; Closed Fracture Reduction/methods* ; Olecranon Fracture

OBJECTIVE To explore the intervention mechanism of Shangke Lengtongtie on cold hyperalgesia in KOA mice based on the HMGB1/CXCL12/CXCR4 signaling axis.METHODS Monosodium iodoacetate(MIA)was used for the intra-articular injec-tion into the knee joint to establish mice model of knee osteoarthritis(KOA).Peripheral blood monocytes were extracted from mice,cultured,and then reinfused into the tail vein of the mice.Subsequently,in vivo animal imaging was used to observe the recruitment sites of these monocytes.The cold hyperalgesia threshold was measured at various time points in each group of mice.Hematoxylin and eosin(HE)staining was used to evaluate the level of synovial pathological changes.ELISA was employed to detect the expression of in-flammatory factors IL-1β,TNF-α,and pain mediators CGRP and Substance P in mouse serum.Western blot and qPCR methods were used to detect the protein and gene expression of cold hyperalgesia-related indicators such as TRPA1,TRPM8,HMGB1,CXCL12,CXCR4,Collagen Ⅰ,and Netrin-1 in synovial tissue,as well as DCC in dorsal root ganglia(DRG)tissue.RESULTS In vivo ima-ging showed that after the monocytes were reinfused into KOA mice,they were recruited to the knee joint area,with the HMGB1 group exhibiting a greater recruitment of circulating monocytes at the knee joint.Additionally,compared to the control group,the KOA group and HMGB1 group showed inflammatory pathological changes in the synovium,increased expression of serum inflammatory factors and pain mediators,reduced cold hyperalgesia threshold,and upregulated protein and gene expression of cold hyperalgesia-related indica-tors in synovial and DRG tissues.The changes were more significant in the HMGB1 group compared to the KOA group(P<0.05).Af-ter treatment with Shangke Lengtongtie or GL intervention,synovial inflammation was alleviated,serum inflammatory factors and pain mediators decreased,cold hyperalgesia threshold increased,and the upregulation of cold hyperalgesia-related indicator protein and gene expression levels was significantly reversed(P<0.05).CONCLUSION Shangke Lengtongtie exerts a beneficial effect on the mitigation of synovitis and cold hyperalgesia in KOA mice,a therapeutic mechanism that possibly mediated through the inhibition of the HMGB1/CXCL12/CXCR4 signaling axis.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

In recent years,the microorganisms residues in endoscopes have frequently resulted in cross transmis-sion or even the outbreak of hospital-associated infections.It is of great importance to carry out standardized bio-logical surveillance of endoscopes,find out the high-risk links of cleaning and disinfection,and take targeted inter-vention measures to reduce the incidence of endoscopy-related infection.Based on the related guidelines in China and abroad as well as the latest clinical practice researches,the biological surveillance sampling and culture for en-doscopes were summarized in the article so as to enhance the surveillance quality,ensure the reprocessing effect and guarantee the endoscopy-related quality and safety.

Objective:To investigate the associations between MRI texture features and genetic mutations in clear cell renal cell carcinoma (ccRCC) and non-ccRCC (n-ccRCC).Methods:This was a cross-section study. A retrospective review was performed on 31 patients (ccRCC group 19 cases and n-ccRCC group 12 cases) diagnosed with renal cell carcinomas and underwent targeted sequencing between April 2011 and December 2021 in the Third Affiliated Hospital of Soochow University. All the patients underwent MRI examinations within two weeks before partial or radical nephrectomy. Texture features were extracted from T 1WI, T 2WI, Dixon-MRI, cortical-medulla phase (CMP), nephrographic phase (NGP), and delayed phase (DEP) images. MRI texture features with the highest value for distinguishing ccRCC from n-ccRCC were selected for subsequent analysis. The next-generation high-throughput sequencing technology was employed to analyze gene mutations in renal tumors. The correlation between mutation genes and texture features in ccRCC and n-ccRCC was analyzed using Spearman correlation coefficient. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation analysis was performed. Results:A total of 8 MRI texture features were selected. In the ccRCC group, PTEN mutation was correlated with DEP_InverseDifferenceMoment_angle0_offset7 ( r=-0.58, P=0.009). In the non-ccRCC group, SETD2 mutation was correlated with CM_Phase_InverseDifferenceMoment_AllDirection_offset1 and Dixon_W_InverseDifferenceMoment_AllDirection_offset7 ( r=0.58, 0.63, P=0.048, 0.027), PBRM1 mutation was correlated with DE_Phase_InverseDifferenceMoment_angle0_offset7 and DE_Phase_HaraVariance ( r=0.61, -0.60, P=0.034, 0.039), and FAT1 mutation was correlated with DE_Phase_HaraVariance and NG_Phase_Inertia_angle135_offset4 ( r=0.58, 0.58, P=0.047, 0.047). The KEGG pathway annotation analysis showed that the mechanisms of the mutation genes that correlated with MRI texture features in the ccRCC group were related to the p53 signaling pathway, inositol phosphate metabolism, central carbon metabolism in cancer, EGFR tyrosine kinase inhibitor resistance, PD-L1 expression and PD-1 checkpoint pathway in cancer, and phosphatidylinositol signaling system. The mutation genes correlated with MRI texture features in the non-ccRCC group were mainly associated with lysine degradation. Conclusion:The associations are found between MRI texture features and underlying genetic mutations of ccRCC and n-ccRCC. These mutation genes have completely different enrichment pathways.

Objective:To explore the correlation between renal function and abdominal aortic hemodynamic parameters based on four-dimensional flow(4D Flow) MRI in patients with chronic kidney disease (CKD).Methods:A cross-section prospective study was conducted on 73 patients diagnosed with CKD at First People′s Hospital of Changzhou between March 2021 and May 2023, as well as 13 volunteers without kidney injury. According to the estimated glomerular filtration rate (eGFR), the subjects were divided into CKD 1-3 stage group ( n=34), CKD 4-5 stage group ( n=39), and control group ( n=13). All subjects underwent 4D Flow MRI examination of the abdominal aorta, measuring pulse wave velocity (PWV), peak velocity, and maximum wall shear stress (WSS) at the proximal plane (Plane_1) and the higher renal artery opening plane (Plane_2) of the abdominal aorta. The differences in 4D Flow MRI hemodynamic parameters among the three groups were compared using a one-way analysis of variance or the Kruskal-Wallis test. The correlation between 4D Flow MRI hemodynamic parameters and eGFR was analyzed by using the Spearman correlation coefficient. The independent influencing factors that affect eGFR were analyzed by using multivariate linear regression analysis. Results:There were significant differences in abdominal aortic PWV and maximal WSS of Plane_1 and Plane_2 among the three groups ( H=10.38, P=0.006; F=11.16, P<0.001; F=4.75, P=0.011). There were no significant differences in the peak velocity of Plane_1 and Plane_2 among the three groups (both P>0.05). Abdominal aortic PWV was negatively correlated with eGFR ( r s=-0.30, P=0.005). There was a positive correlation between the maximal WSS of Plane_1 and Plane_2 with eGFR ( r s=0.39, P<0.001; r s=0.29, P=0.006). Abdominal aortic PWV and maximal WSS of Plane_1 were independent influencing factors of eGFR (b=-4.32, P=0.018; b=132.23, P=0.004). Conclusions:There is an independent correlation between renal function and abdominal aortic hemodynamic parameters based on 4D Flow MRI in patients with CKD, and abdominal aortic PWV and maximal WSS of Plane_1 were independent influencing factors of eGFR.

OBJECTIVE To explore the intervention mechanism of Shangke Lengtongtie on cold hyperalgesia in KOA mice based on the HMGB1/CXCL12/CXCR4 signaling axis.METHODS Monosodium iodoacetate(MIA)was used for the intra-articular injec-tion into the knee joint to establish mice model of knee osteoarthritis(KOA).Peripheral blood monocytes were extracted from mice,cultured,and then reinfused into the tail vein of the mice.Subsequently,in vivo animal imaging was used to observe the recruitment sites of these monocytes.The cold hyperalgesia threshold was measured at various time points in each group of mice.Hematoxylin and eosin(HE)staining was used to evaluate the level of synovial pathological changes.ELISA was employed to detect the expression of in-flammatory factors IL-1β,TNF-α,and pain mediators CGRP and Substance P in mouse serum.Western blot and qPCR methods were used to detect the protein and gene expression of cold hyperalgesia-related indicators such as TRPA1,TRPM8,HMGB1,CXCL12,CXCR4,Collagen Ⅰ,and Netrin-1 in synovial tissue,as well as DCC in dorsal root ganglia(DRG)tissue.RESULTS In vivo ima-ging showed that after the monocytes were reinfused into KOA mice,they were recruited to the knee joint area,with the HMGB1 group exhibiting a greater recruitment of circulating monocytes at the knee joint.Additionally,compared to the control group,the KOA group and HMGB1 group showed inflammatory pathological changes in the synovium,increased expression of serum inflammatory factors and pain mediators,reduced cold hyperalgesia threshold,and upregulated protein and gene expression of cold hyperalgesia-related indica-tors in synovial and DRG tissues.The changes were more significant in the HMGB1 group compared to the KOA group(P<0.05).Af-ter treatment with Shangke Lengtongtie or GL intervention,synovial inflammation was alleviated,serum inflammatory factors and pain mediators decreased,cold hyperalgesia threshold increased,and the upregulation of cold hyperalgesia-related indicator protein and gene expression levels was significantly reversed(P<0.05).CONCLUSION Shangke Lengtongtie exerts a beneficial effect on the mitigation of synovitis and cold hyperalgesia in KOA mice,a therapeutic mechanism that possibly mediated through the inhibition of the HMGB1/CXCL12/CXCR4 signaling axis.

OBJECTIVE To explore the effectiveness and possible mechanism of Shangke Lengtong Patch in treating knee osteo-arthritis with cold-dampness arthralgia obstruction.METHODS A total of 70 patients who met the inclusion criteria of knee osteoar-thritis with cold-dampness arthralgia obstruction in the Orthopedics Department of Affiliated Hospital of Nanjing University of Chinese Medicine from November to December 2024 were randomly divided into an experimental group and a control group,with 35 cases in each group.During the treatment,1 case dropped out of the experimental group,3 cases dropped out of the control group,and 1 case was discontinued.The experimental group was treated with Shangke Lengtong Patch,and the control group was treated with Compound Nanxing Zhitong Ointment.The WOMAC scores and TCM syndrome scores of the two groups before and after treatment were compared to comprehensively evaluate the clinical efficacy.The changes in the expression levels of CGRP,substance P,HMGB1,IL-1β,CX-CL12,and CXCR4 in the serum of the two groups were detected by ELISA.RESULTS After 3,7,and 14 d of treatment,the WOMAC scores and TCM syndrome scores of the two groups were significantly reduced(P<0.05,P<0.01),and the score of aggrava-ted cold in the experimental group was better than that in the control group at 7 d of treatment(P<0.05);after 14 d of treatment,the expression levels of CGRP,substance P,HMGB1,IL-1β,CXCL12,and CXCR4 in the serum of the two groups were significantly re-duced(P<0.05),and there was no statistical difference between the two groups.CONCLUSION Shangke Lengtong Patch can sig-nificantly relieve the pain symptoms of knee osteoarthritis patients with cold-dampness arthralgia obstruction and improve the joint func-tion of patients.It may improve synovial inflammation by inhibiting the HMGB1/CXCL12/CXCR4 pathway,thereby exerting a thera-peutic effect.

Objective The aim of this study was to analyze the incidence trend and age-specific characteristics of esophage-al cancer in cancer registration areas of Gansu Province from 2010 to 2021,and predict the incidence of esophageal cancer from 2022 to 2030.Methods Based on the incidence data of esophageal cancer in 15 cancer registries in Gansu Province from 2010 to 2021,the incidence was calculated by age,sex,urban and rural areas.The age-standardized incidence by Chinese standard population(ASIRC)was standardized using the 2000 Chinese standard population.Joinpoint regression model was used to analyze the change trend of esophageal cancer incidence,and the average annual percentage change(AAPC)was calculated to quantify the overall rate of change.A birth cohort model was constructed to analyze incidence trend of different birth groups from 1930 to 2021,and the Bayesian age-period-cohort(BAPC)model was used to predict incidence.Results From 2010 to 2021,the ASIRC of esophageal cancer in Gansu Province showed a significant downward trend(AAPC=-14.47％,95％CI:-18.72％--9.99％,P＜0.001).The ASIRC in men decreased at an annual rate of 13.02％(AAPC=-13.02％,95％CI:-17.28％--8.54％,P＜0.001),the incidence of esophage-al cancer in women at a rate of 15.80％per year(AAPC=-15.80％,95％CI:-20.69％--10.61％,P＜0.001).The ASIRC of e-sophageal cancer in urban areas decreased at an annual rate of 15.32％(AAPC=-15.32％,95％CI:-21.04％--9.18％,P＜0.001);ASIRC of esophageal cancer in rural areas decreased at a rate of 5.33％per year(AAPC=-5.33％,95％CI:-8.94％--1.58％,P＜0.001).From 2010 to 2021,the incidence of esophageal cancer in all age groups showed a significant downward trend(AAPC:-19.59％to-9.18％).The birth cohort analysis revealed that the incidence of esophageal cancer in people over 40 years old in the province,men,women,urban and rural areas showed a downward trend with increase of birth years.BAPC model predicted that that the ASIRC of esophageal cancer for the total province population,men and women would decrease from 6.47/100,000,10.02/100,000,and 2.95/100,000 in 2021 to 1.31/100,000,1.72/100,000,and 0.91/100,000 in 2030,respectively.Conclu-sions The incidence of esophageal cancer in Gansu Province showed a downward trend from 2010 to 2021,but men and rural areas were still the focus of high incidence.The prediction indicates that the incidence of esophageal cancer in Gansu Province will further decline by 2030,suggesting that the prevention and control measures have achieved results;however,it is still necessary to strengthen the intervention and long-term monitoring of high-risk groups.