BACKGROUND:Palmar locking plate fixation is the most commonly used fixation method for distal radius fractures.However,when the fracture line involves the dorsal articular surface,palmar plate fixation carries a higher risk of postoperative displacement of the dorsal bone mass,especially the dorsal sigmoid notch bone mass. OBJECTIVE:To analyze the fracture line characteristics of distal radius fracture involving the dorsal articular surface,and further investigate the risk factors of postoperative displacement of the dorsal bone mass involving the sigmoid notch,so as to provide evidence for improving the success rate of surgery. METHODS:Retrospective analysis was performed on patients with distal radius fracture who were admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2021 to September 2022.The number of dorsal fractures of the distal radius of 1,2,3 and above was divided into types Ⅰ,Ⅱ,and Ⅲ based on preoperative CT images.The fracture line maps were drawn respectively to analyze the morphological characteristics of the dorsal fracture lines.Patients with dorsal sigmoid notch fracture were followed up for more than 3 months and divided into displaced group and non-displaced group according to whether the dorsal sigmoid notch bone mass displacement occurred after surgery.Age,sex,preoperative and postoperative CT anatomical parameters were compared between the two groups. RESULTS AND CONCLUSION:(1)145 patients with type C of AO/OTA involving the dorsal articular surface were analyzed by fracture line map.According to the number of dorsal fractures,there were 25 cases of type Ⅰ fracture(17.2％),82 cases of type Ⅱ fracture(56.6％),and 38 cases of type Ⅲ fracture(26.2％).Fracture line map showed that the fracture line of type Ⅰ fracture block mainly involved sigmoid notch;type Ⅱ mainly involved sigmoid notch and lister tubercle,and type Ⅲ involved sigmoid notch,lister tubercle,and dorsal radial column.Among the 145 patients,86.2％(125/145 cases)were involved in sigmoid notch,of which type Ⅲ was involved as high as 94.7％(36/38 cases);type Ⅱ was involved as high as 88.0％(72/82 cases),and type Ⅰ was involved as high as 68％(17/25 cases).(2)76 cases of type C of AO/OTA involving the dorsal sigmoid notch were included for further study,of which 65 cases were not displaced after operation and 11 cases were displaced.In univariate analysis,there were no statistically significant differences between the two groups in age,sex,injury site,preoperative CT dorsal sigmoid notch bone mass length(d1),ulnar length(d2),dorsal height of dorsal sigmoid notch bone mass(d4),and ulnar edge distance between steel plate and radius(d5)(P>0.05).The proportion of dorsal sigmoid notch involving the radioulnar joint:[d2/(d2+d3)],the proportion of articular surface of dorsal sigmoid notch(s1/s2),the distance between the ulnar screw tail and the edge of dorsal sigmoid notch(d6),and the number of screw fixation of dorsal sigmoid notch were statistically significant(P<0.05).(3)Multivariate Logistic regression analysis showed that the number of screw fixation of sigmoid notch was the only risk factor affecting the displacement of sigmoid notch on dorsal ulnar side(P<0.05).(4)It is indicated that type Ⅱ is the most common intra-articular fracture of distal radius involving the back of the radius,followed by type Ⅲ and type Ⅰ with dorsal sigmoid notch bone mass.However,the dorsal sigmoid notch bone mass is prone to postoperative displacement due to the influence of the inferior radioulnar joint ligament,and the fixation of at least one effective screw during the operation can reduce the risk of displacement and help to improve the treatment effect.

Objective To investigate dynamic changes in myocardial protein phosphorylation during the acute phase of myocardial infarction (MI) in mice. Methods Six 8-week-old C57BL/6J mice were randomly assigned to MI model (n＝3) or sham-operated control (n＝3) groups. Cardiac tissues were harvested 72 hours post-intervention for proteomic analysis. Phosphorylation modifications were systematically characterized using liquid chromatography-mass spectrometry (LC-MS). Bioinformatics analyses included differential phosphorylation screening, functional enrichment, hierarchical clustering, and protein-protein interaction network. Results LC-MS identified 1 921 differentially phosphorylated sites (20 tyrosine and 1 901 serine/threonine sites) across 851 proteins. Compared with controls, MI hearts exhibited significant phosphorylation upregulation at 1 545 sites and downregulation at 376 sites (P＜0.05). Conclusions This study delineates MI-associated phosphorylation dynamics, providing mechanistic insights and potential therapeutic targets for acute MI intervention.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

: Bacteroides, as one of the most abundant and diverse genera in the human gut, is regarded as a window into the study of gut microbiota-host interactions. Currently, CRISPR/Cas-based gene editing systems targeting Bacteroides have been widely applied, while the large size of Cas nucleases limits their potential application scenarios (such as in situ gut Bacteroides editing based on phage delivery). Therefore, this study aims to develop a compact and highly efficient genetic editing tool in Bacteroides., We developed a miniaturized CRISPR/Cas gene editing system for human gut Bacteroides. First, the editing capabilities of different miniaturized CRISPR/Cas systems, including AsCas12f, CasΦ2, and ISDge10, were evaluated in Bacteroides fragilis. Subsequently, the editing capability of AsCas12f was assessed across various Bacteroides species, and the size of this system was further optimized. The results demonstrated that the CRISPR/AsCas12f genome editing system exhibited the highest editing efficiency in B. fragilis. The CRISPR/AsCas12f system achieved efficient genome editing in B. fragilis, Bacteroides thetaiotaomicron, and Phocaeicola vulgatus. Furthermore, with a repair template of 500 bp homologous arms, the editing efficiency remained as high as 94.7%. In conclusion, CRISPR/AsCas12f can serve as a chassis tool enzyme for the development of Bacteroides-based miniature gene editors and derivative technologies, laying a foundation for the further development of gene editing technology for Bacteroides.
CRISPR-Cas Systems/genetics* ; Gene Editing/methods* ; Bacteroides/genetics* ; Humans ; Gastrointestinal Microbiome/genetics* ; Bacteroides fragilis/genetics*

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

BACKGROUND:Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures,but its failure rate is still high in clinical practice.Reasonable screw placement is an important factor affecting the stability of internal fixation. OBJECTIVE:To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure. METHODS:From January 2017 to December 2021,data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed.A total of 124 patients were enrolled,including 16 males and 108 females,at the age of≥60 years.According to whether there was internal fixation failure after operation,they were divided into normal group(n=101)and internal fixation failure group(n=23).The patient's age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether the talus screw was inserted,and the number of humeral head screws,were collected.The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film,and the distribution characteristics of the screws in each zone were collected,and the heat map of the screw distribution was drawn. RESULTS AND CONCLUSION:(1)There were no significant differences between the two groups in age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether to insert talus screws,and the number of humeral head screws(P>0.05).(2)The heat map showed that the humeral head screws were evenly distributed in the normal group,mainly scattered in zones 4,6,and 7.However,the screw distribution in the internal fixation failure group was not uniform,mainly concentrated in zones 4 and 6.In addition,in the ideal area of talus screws(7/8 zone),there were significantly more screws in the normal group than in the internal fixation failure group.(3)It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate,the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect.A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation.

Objective To compare the interaction efficiency of three human-machine interaction modes with hand-touch control,eye movement control and voice control,based on a multi-channel human-machine interaction system in flight mission scenarios.Methods 20 pilots took part in the study and completed the first level(relatively simple)and second level(relatively complex)interactive experimental tasks in three human-computer interaction modes based on specific flight mission scenarios.The interaction efficiency indicators included the system's interaction time,response time,fusion calculation time,and number of errors.After the experiment was completed,the pilots conducted a subjective evaluation,which included the suitability of the interaction mode to the task,consistency with expected usage,fault-tolerance,effective feedback,and the tendency of the interaction mode to be applied in future flight fields.Results There were generally significant differences in interaction efficiency between hand-touch control,voice control,and eye movement control in flight mission scenarios,but the differences differed in first-level and second-level interaction tasks.Based on the comprehensive interaction experimental tasks at all levels,the experimental results obtained included:(1)the interaction time of hand-touch control was the shortest,the interaction time of voice control was the longest,and the main effect of the interaction mode was significant(F=18.214,P<0.001,η2=0.565);(2)The response time of hand-touch control was the shortest,while the response time of eye movement control was the longest.The main effect of interaction mode was significant(F=153.085,P<0.001,η2=0.944);(3)The fusion calculation time for hand-touch control was the shortest,while the fusion calculation time for voice control was the longest.The main effect of the interaction mode was significant(F=41.702,P<0.001,η2=0.777);(4)The errors in voice control were the least,while those in eye movement control were the most.The main effect of interaction mode was significant(χ2=22.845,P<0.001,φ=1.097);(5)The subjective evaluation scores of pilots on voice control were higher than those on eye movement control,and all had statistical significance(P<0.001,P<0.01).Conclusions This study focuses on flight interaction tasks and compares the interaction efficiency of three interaction modes of hand-touch control,voice control,and eye movement control,through a combination of experiments and subjective evaluations.The differences in various interaction efficiency indicators among different interaction modes are found,and the interaction modes have a significant impact on interaction efficiency.Hand-touch control has a significant advantage in interaction time efficiency,voice control has an advantage in accuracy for simple tasks,while eye movement control has relatively weak time efficiency and accuracy;Compared to eye movement control,pilots exhibit higher evaluations and tendencies towards voice control.The research results can provide reference for the future design,evaluation,and application of multi-modal interaction systems.

Objective:To investigate the clinicopathologic features of sarcomatoid carcinoma of the pancreas.Methods:The clinicopathological data of 7 cases with sarcomatoid carcinoma of the pancreas admitted in the Affiliated Lihuili Hospital of Ningbo University from September 2013 to August 2021 were retrospectively analyzed, including clinical manifestations, laboratory examination, imaging examination, pathological examination of tissue specimens, surgical methods and adjuvant treatments. Expressions of mesenchymal markers and epithelial markers in tumor tissues were determined by immunohistochemical staining.Results:Among the 7 cases of sarcomatoid carcinoma of the pancreas, there were 4 male and 3 female. The patient age ranged from 51 to 88 years old, and the mean age was 69 years old. All the patients underwent CT examimation before surgery. 3 tumors were located in the head, 3 in the body and 1 in the tail of the pancreas. CT examination also showed that 4 tumors were cystic solid and 3 were cystic. Six patients underwent radical surgery and one underwent partial resection for biopsy. Microscopically, the tumor was predominantly composed of sarcomatoid spindle-shaped cells. Immunohistochemical staining showed that the tumor expressed both mesenchymal markers vimentin and epithelial marker CK7, CK19, CK(pan) and CAM5.2. The overall prognosis of the patients was poor, 4 cases died within 1 year after surgery, and the other 3 cases survived without recurrence.Conclusions:The clinical manifestations of sarcomatoid carcinoma of the pancreas were not typical, but the pathological and immunohistochemical features are obvious and the prognosis is poor.

AIM:To systematically evaluate the clinical interchangeability of adalimumab biosimi-lars in terms of efficacy,safety,and immunogenici-ty,and to provide evidence-based reference for clinical interchangeability.METHODS:Randomized Controlled Trials(RCTs)on the interchangeability of adalimumab biosimilars were systematically searched in PubMed,Embase,Cochrane Library,CNKI,WANFANG and SinoMed from inceptions to October 2023.Data were extracted from the litera-ture that met the inclusion criteria,risk of bias was assessed using the Cochrane Handbook for System-atic Reviews of Interventions 5.0 bias risk assess-ment tool.Meta-analysis was performed using Rev-man 5.4 software.The certainty of evidence was graded using the GRADE tool recommended by the Cochrane Collaboration.This study was conducted according to the PRISMA guideline.RESULTS:Eigh-teen studies were included,with 7 focusing on pso-riasis and 11 on rheumatoid arthritis.Regarding ef-ficacy,for psoriasis,there were no statistical differ-ences in PASI 75 response rates and sPGA scores of ≤1 after 1-4 switches between biosimilars and the reference drug(P＞0.05,moderate-quality evi-dence).For rheumatoid arthritis,there were no sta-tistical differences in ACR 20/50/70 response rates after 1-3 switches(P＞0.05,moderate-quality evi-dence).Regarding safety,there were no statistical differences in the risk of adverse events after single or multiple switches for both diseases(P＞0.05,moderate-quality evidence).Regarding immunoge-nicity,there were no statistical differences in the rate of anti-drug antibody production after single or multiple switches(P＞0.05,moderate-quality evi-dence).High-quality evidence is still lacking for the interchangeability of adalimumab biosimilars in other indications.CONCLUSION:The switches be-tween adalimumab biosimilars and the reference drug have no significant impact on clinical efficacy,safety and immunogenicity for psoriasis and rheu-matoid arthritis patients.