OBJECTIVE: To investigate the effectiveness of digital three-dimensional (3D) printing osteotomy guide plate assisted total knee arthroplasty (TKA) in treatment of knee osteoarthritis (KOA) patients with femoral internal implants. METHODS: The clinical data of 55 KOA patients who met the selection criteria between July 2021 and October 2023 were retrospectively analyzed. Among them, 26 cases combined with femoral implants were treated with digital 3D printing osteotomy guide plate assisted TKA (guide plate group), and 29 cases were treated with conventional TKA (control group). There was no significant difference in gender, age, body mass index, side, Kellgren-Lawrence classification, preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, knee range of motion, and other baseline data between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, postoperative first ambulation time, surgical complications; VAS score, knee HSS score, knee range of motion before operation, at 1 week and 3 months after operation, and at last follow-up; distal femoral lateral angle, proximal tibial medial angle, hip-knee-ankle angle and other imaging indicators at last follow-up were recorded and compared between the two groups. RESULTS: The operation time, incision length, intraoperative blood loss, and postoperative first ambulation time in the guide plate group were significantly lower than those in the control group ( P<0.05). In the control group, there were 1 case of incision rupture and bleeding and 1 case of lower limb intermuscular venous thrombosis, which was cured after symptomatic treatment. There was no complication such as neurovascular injury, incision infection, or knee prosthesis loosening in both groups. Patients in both groups were followed up 12-26 months, with an average of 16.25 months. The VAS score, HSS score, and knee range of motion improved at each time point after operation in both groups, and further improved with time after operation, the differences were significant ( P<0.05). The above indicators in the guide plate group were significantly better than those in the control group at 1 week and 3 months after operation ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). At last follow-up, the distal femoral lateral angle, the proximal tibial medial angle, and the hip-knee-ankle angle in the guide plate group were significantly better than those in the control group ( P<0.05). CONCLUSION The application of digital 3D printing osteotomy guide plate assisted TKA in the treatment of KOA patients with femoral implants can simplify the surgical procedures, overcome limitations of conventional osteotomy guides, reduce surgical trauma, achieve individualized and precise osteotomy, and effectively restore lower limb alignment and knee joint function.
Humans ; Arthroplasty, Replacement, Knee/instrumentation* ; Osteoarthritis, Knee/surgery* ; Osteotomy/instrumentation* ; Male ; Retrospective Studies ; Female ; Printing, Three-Dimensional ; Femur/surgery* ; Middle Aged ; Bone Plates ; Range of Motion, Articular ; Aged ; Treatment Outcome ; Surgery, Computer-Assisted/methods* ; Knee Prosthesis ; Knee Joint/surgery* ; Operative Time

Objective To explore the effect of delayed Kirschner wire fixation after emergency pre-reduction with traditional Chinese medicine bone-setting manipulation in the treatment of supracondylar fracture of humerus in children.Methods Sixty patients with supracondylar fracture of humerus admitted to Jiangxi Provincial Children's Hospital from June 2022 to June 2023 were selected and divided into observation group and control group according to the random number table method,with 30 cases in each group.The observation group adopted emergency pre-reduction with traditional Chinese medicine bone-setting manipulation and delayed surgical reduction,and the control group underwent delayed surgical reduction.The operation time,intraoperative fluoroscopy frequency,reduction condition,postoperative complications,elbow joint function at the last follow-up of two groups of children were compared.Results The operation time of children in observation group was significantly shorter than that in control group,and the number of fluoroscopy was significantly less than that in control group(P＜0.05).The proportion of anatomical reduction in observation group was significantly higher than that in control group(P＜0.05).There was no statistically significant difference in fracture healing time between two groups of children(P＞0.05).Neither of two groups of children had conversion incision,postoperative re-displacement of fractures,nerve injury,infection,cubitus varus or elbow valgus deformity,etc..At the last follow-up,there was no statistically significant difference in the excellent and good rate of elbow joint function between two groups of children(P=0.301).Conclusion Emergency traditional Chinese medicine bone-setting manipulation in the treatment of supracondylar fracture of humerus in children can shorten the operation time,reduce the radiation dose,alleviate the burden of emergency medical treatment,have no obvious complications,and have a good effect.It is worthy of promotion.

Objective: To investigate the regulatory role of ABCG5 in head and neck squamous cell carcinoma. Methods : Immunohistochemical staining was used to detect the expression of ABCG5 in 105 patients with hypopharyngeal carcinoma,and the relationship between the expression and the long-term survival time of the patients was analyzed.Immunowestern blotting and flow cytometry were used to detect the expression of ABCG5 in head and neck squamous cell carcinoma cell lines.Flow sorting was employed to investigate the differences in proliferation and metastasis,spheroidization ability,and expression of stem cell molecules between ABCG5 positive and negative cells.si RNA interference was used to further demonstrate whether ABCG5 affects the malignant phenotype. Results: ABCG5 was associated with poor prognosis in patients with hypopharyngeal carcinoma.ABCG5 was enriched in stem cells of head and neck squamous cell carcinoma.ABCG5-positive cells had stronger proliferation(P<0.001),metastasis(P<0.01),and spheroid formation abilities(P<0.001) than negative cells.The expression levels of some stem cell molecules(SOX2、NANOG、SOX9、OCT4、CD44) in ABCG5-positive cells were higher than those in ABCG5-negative cells.The expression of epithelial cell protein E-cadherin was lower in ABCG5-positive cells than that in ABCG5-negative cells,and the expression of interstitial cell proteins N-cadherin,Slug,Snail 1,and Vimentin were higher(P<0.01).Moreover,interfering with ABCG5 expression significantly inhibited tumor cell spheroid formation(P<0.001),as well as the expression of proteins related to cancer stem cells and epithelial-mesenchymal transition. Conclusion ABCG5 has a potential biological role in maintaining the function of head and neck squamous cell carcinoma stem cells.

Objective To explore the effect of delayed Kirschner wire fixation after emergency pre-reduction with traditional Chinese medicine bone-setting manipulation in the treatment of supracondylar fracture of humerus in children.Methods Sixty patients with supracondylar fracture of humerus admitted to Jiangxi Provincial Children's Hospital from June 2022 to June 2023 were selected and divided into observation group and control group according to the random number table method,with 30 cases in each group.The observation group adopted emergency pre-reduction with traditional Chinese medicine bone-setting manipulation and delayed surgical reduction,and the control group underwent delayed surgical reduction.The operation time,intraoperative fluoroscopy frequency,reduction condition,postoperative complications,elbow joint function at the last follow-up of two groups of children were compared.Results The operation time of children in observation group was significantly shorter than that in control group,and the number of fluoroscopy was significantly less than that in control group(P＜0.05).The proportion of anatomical reduction in observation group was significantly higher than that in control group(P＜0.05).There was no statistically significant difference in fracture healing time between two groups of children(P＞0.05).Neither of two groups of children had conversion incision,postoperative re-displacement of fractures,nerve injury,infection,cubitus varus or elbow valgus deformity,etc..At the last follow-up,there was no statistically significant difference in the excellent and good rate of elbow joint function between two groups of children(P=0.301).Conclusion Emergency traditional Chinese medicine bone-setting manipulation in the treatment of supracondylar fracture of humerus in children can shorten the operation time,reduce the radiation dose,alleviate the burden of emergency medical treatment,have no obvious complications,and have a good effect.It is worthy of promotion.

Background:Autoimmune gastritis(AIG)is a CD4+T cell-mediated immune disease.In recent years,with increased awareness and understanding of the condition,reports of AIG cases in China have been gradually increasing.Aims:To analyze and summarize the clinical characteristics of AIG for better disease recognition and diagnosis.Methods:Data on AIG patients diagnosed at the First Affiliated Hospital of Zhejiang Chinese Medical University from August 2018 to December 2023 were collected and analyzed for their clinical,laboratory,endoscopic,and pathological features.Results:A total of 161 AIG patients were included,with the mean age of 56.81 years old,63 were males and 98 females.Most of the patients exhibited no characteristic clinical symptoms.The laboratory measurements were as follows:gastrin-17,44.68 pmol/L;pepsinogen(PG)Ⅰ,38.61 μg/L;PG Ⅱ,10.41 μg/L;PGⅠ/Ⅱ ratio,32.1;vitamin B12,344.45 pmol/L;and hemoglobin,125.15 g/L.The positivity rates of thyroglobulin antibody and thyroid peroxidase antibody were 46.0%and 30.0%,respectively.The main comorbid autoimmune diseases were Hashimoto's thyroiditis(8.1%)and rheumatoid arthritis(5.0%).One hundred and seven cases exhibited the"reverse atrophy"phenomenon,while 54 cases showed pan-gastric atrophy,predominantly in the fundus and body.Fifteen cases were diagnosed as gastric neuroendocrine tumors(NET)or gastric carcinoma.Pathological analysis of 90 gastric mucosal specimens showed 24 cases of lymphocyte and plasma cell infiltration without significant atrophy,42 cases of glandular atrophy and lymphocyte infiltration,and 24 cases of enterochromaffin cell hyperplasia and the formation of endocrine micro-nests.Conclusions:AIG is more common in middle-aged and elderly individuals,with a slightly higher prevalence in females and a frequent association with anemia.It should be suspected in patients with low PGⅠ level and hypergastrinemia.Due to the increased risk of gastric adenocarcinoma and NETs,regular endoscopic monitoring is recommended.

Objective:To evaluate the clinical efficacy of modified endoscopic mucosal resection (EMR) in the management of early gastrointestinal lesions.Methods:Upon endoscopic identification of the lesion, normal saline is injected into the submucosa to establish a fluid cushion, which elevates the lesion's mucosa. Methylene blue may also be applied to improve visualization of the relationship between the submucosa and muscular layer. A snare with a tip diameter of 2-3 mm is utilized to circumferentially incise the mucosal layer at the lesion's edge, forming a circular groove. The snare is anchored within this groove, allowing for complete resection of the lesion in a single step. The procedure involves a slow and alternating technique of electrosurgical cutting and coagulation to minimize bleeding risks, while upward tension on the snare during cutting reduces perforation risks. Direct coagulation of exposed blood vessels is performed using the snare tip, and hemostatic clips are applied to larger defects; nylon sutures may be utilized for substantial wounds.Results:Between June 2015 and April 2024, modified EMR was performed on 65 patients with early gastrointestinal lesions at Dongguan Children's Hospital, Guangdong Medical University. The mean operative time was (15.2 ± 3.1) minutes, with a complete resection rate of 100% and negative margins confirmed. Postoperative complications included one case each of delayed bleeding and electrosurgical syndrome. The average cost of consumables was (1887.2±187.6) yuan. Follow-up colonoscopies at 3 and 6 months postoperatively indicated no recurrences.Conclusions:Modified EMR demonstrates a short operative time, high safety and efficacy, and reduced material costs in the treatment of early gastrointestinal mucosal lesions.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective To grasp the main environmental factors affecting the growth of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao;To predict the distribution of suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province;To provide references for the rational distribution of the resources in Shanxi Province.Methods This study utilized the sample point longitude and latitude information collected in the"Fourth Survey of Chinese Materia Medica Resources"database in Shanxi Province.The data were supplemented by searching the China Digital Herbarium and retrieving related literature records.347 sample points distribution data and environmental factors were added to the MaxEnt model.The main environmental factors and contribution rates affecting the geographical distribution of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao were screened out.The ArcGIS software was used to divide the ecological suitable area of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province.Results The area under the ROC curve of the established MaxEnt model was 0.909,indicating that the model prediction results were accurate.The model screened 19 environmental factors.Among them,climate factor was the most important environmental factor,followed by biological factor and topographic factor,and soil factor had the least influence.The potential suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province were mainly distributed in the northern mountainous areas,presenting a trend of gradually decreasing suitability levels from north to south.Under the current climate conditions,the most suitable area for Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province was 15 424 km2,the suitable area was 19 856 km2,the sub suitable area was 59 436 km2,and the unsuitable area was 61 894 km2.Conclusion Based on MaxEnt model and ArcGIS software,this study predicts the distribution of suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province,which has certain reference value for the protection and rational distribution of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao resources in Shanxi Province.

Objective:To understand the breastfeeding situation in the neonatal intensive care units (NICUs) in Qianxinan Prefecture, Guizhou Province, and to assess the knowledge, attitudes, and practices of doctors and nurses regarding breastfeeding, aiming to provide foundational data for improving breastfeeding quality.Methods:A questionnaire was developed to survey the knowledge, attitudes, and practices related to breastfeeding in NICUs. The questionnaire was divided into three dimensions: knowledge (seven items, total score of 7), attitudes (nine items, total score of 45), and practices (seven items, total score of 35). Lower scores indicated weaker recognition of breastfeeding. Additionally, five items were included to identify the most influential factors affecting breastfeeding. From November 25 to November 30, 2023, a survey was conducted among doctors and nurses with professional qualifications who had worked in the neonatal departments of nine hospitals in Qianxinan Prefecture for at least one year. Independent sample t-tests and Chi-square tests were used to compare the scores of doctors and nurses from different levels of hospitals and within the same level of hospitals across the three dimensions. Results:(1) Among the nine hospitals, three were tertiary grade A hospitals (referred to as "tertiary hospitals"), with 95.6% (43/45) of the doctors and 96.5% (110/114) of the nurses participating in the survey. Six were secondary grade A hospitals (referred to as "secondary hospitals"), with 95.0% (38/40) of the doctors and 97.6% (83/85) of the nurses participating. (2) All nine hospitals were baby-friendly hospitals and all had breastfeeding promotional materials. Six hospitals had NICUs that promoted breastfeeding, with an average NICU breastfeeding rate of 25.8% across the prefecture between year 2021 to 2023. (3) The proportion of doctors who had received breastfeeding training was higher than that of nurses within the same level of hospitals [tertiary hospitals: 69.8% (30/43) vs. 40.0% (44/110), χ 2=10.97, P=0.001; secondary hospitals: 47.4% (18/38) vs. 24.1% (20/83), χ 2=6.55, P=0.010], although the overall training rates were low. (4) In tertiary hospitals, doctors scored higher than nurses in the attitude dimension [(35.35±4.75) vs. (33.18±5.60) scores, t=－2.03, P=0.044] and also in the practice dimension [(26.98±3.00) vs. (25.60±3.75) scores, t=－2.17, P=0.032]. In secondary hospitals, the total knowledge dimension score of doctors was higher than that of nurses [(4.92±1.44) vs. (4.20±1.45) scores, t=－2.52, P=0.013]. In tertiary hospitals, the total scores for attitude and practice dimensions of doctors were higher than those of doctors in secondary hospitals, and the total scores for knowledge, attitude, and practice dimensions of nurses were higher than those of nurses in secondary hospitals (all P<0.05). (5) In the knowledge dimension, the lowest scoring item of doctors in the tertiary hospitals was "Breastfeeding is possible for maternal hepatitis B newborns after receiving vaccines and immunoglobulin"; the lowest scoring item of nurses in the tertiary hospital, and doctors and nurses in the secondary hospitals was "The duration of breastfeeding has a greater impact on neonatal outcomes". In the attitude dimension, the lowest scoring item for doctors and nurses in both tertiary and secondary hospitals was "You think the breastfeeding process is more troublesome than feeding preterm formula". In the practice dimension, the lowest scoring item of the doctors and nurses in the tertiary hospitals was "Your hospital had enough breastfeeding knowledge training", while for the doctors and nurses in the secondary hospitals were "You have more opportunities to participate in various breastfeeding-related training" and "Breast feeding should be started as soon as possible when the infant is stable after active treatment", respectively. (6) The most influential factors affecting breastfeeding were: lack of cooperation from parents (50.0%, 137/274), relative insufficient human resources for doctors and nurses (21.9%, 60/274), and the absence or poor implementation of breastfeeding management policies (18.3%, 50/274), etc. Conclusions:The breastfeeding rate in NICU of county-level hospitals is relatively low, and medical staff, especially nurses, have insufficient knowledge about breastfeeding. It is necessary to strengthen various breastfeeding training for medical staff to enhance their understanding of NICU breastfeeding.

Patients with Alzheimer′s disease (AD) often exhibit both cognitive and depressive symptoms, suggesting a strong connection between the two, potentially indicating shared pathological factors. This article reviews the common pathological factors underlying cognitive and depressive symptoms in AD, focusing on aspects such as genetic factors, neurodegeneration, hypothalamic pituitary adrenal axis (HPA) dysfunction, neurotrophic factor deficiency, enhanced neuroinflammation, gut microbiota imbalance, and neurotransmitter systems imbalance. Further research on these common pathological factors is of great significance for future AD treatment.