Ruxolitinib， a small molecule inhibitor， selectively targets Janus kinase （JAK） by competitively binding to adenosine triphosphate on the catalytic site of the JAK1 and JAK2 domain， thereby inhibiting JAK activation and signal transducer and activator of transcription （STAT） phosphorylation and prevents the expressions of the JAK-STAT signaling pathway. Oral ruxolitinib has demonstrated promising efficacy for myelofibrosis and polycythemia vera. The topical Ruxolitinib cream， approved by the US FDA as the first non-segmental vitiligo home treatment drug， is set to be launched in domestic medical pioneer areas in August 2023 and is expected to bring about a breakthrough in the treatment of vitiligo. Clinical cases have also shown that Ruxolitinib cream has significant curative effects on atopic dermatitis， alopecia areata， and other conditions， indicating great application prospects.

Objective:To investigate the association between plasma anti-Müllerian hormone(AMH) levels and ischemic stroke.Methods:In this case-control study, 93 ischemic stroke patients were randomly selected as the case group from a study on the prevention and treatment of metabolic syndrome, which was conducted in 2018-2019 in Changshu, Jiangsu Province, while 372 nonischemic stroke patients were selected as the control group according to the principle of 1∶4 matching.An enzyme-linked immunosorbent assay was used to measure plasma AMH levels.The conditional logistic regression model and restricted cubic spline were used to analyze the relationship between AMH levels and ischemic stroke.Results:A total of 465 subjects with an average age of (68.7±7.4)years were included in this study, of whom 215(46.2%)were men and 250(53.8%)were women.According to our conditional Logistic regression analysis, the risk of ischemic stroke was reduced by 44% for every unit increase in the log-AMH level( OR=0.56, 95% CI: 0.37-0.85)in the overall population after multivariate adjustment.Compared with the tertile with the lowest AMH level, the risk of ischemic stroke in the tertile with the highest AMH level decreased significantly( OR=0.37, 95% CI: 0.19-0.69). When subgrouped by sex, the tertiles with the highest AMH levels were associated with a 66% lower risk of ischemic stroke in men( OR=0.34, 95% CI: 0.13-0.88)and a 64% lower risk of ischemic stroke in women( OR=0.36, 95% CI: 0.15-0.87), compared with the tertiles with the lowest AMH levels.The results of restricted cubic spline analysis showed that there was a linear dose-response relationship between plasma AMH levels and ischemic stroke both in the general population and in male or female population( Pvalues for linear trends were 0.0002, 0.008 and 0.007, respectively). Conclusions:Higher plasma AMH levels decrease the risk of ischemic stroke with a dose-response pattern.

Objective To investigate the risk factors affecting the malignancy of amorphous calcifications in the breast and to establish a predictive nomogram.Methods Patients with amorphous calcifications detected by mammography were retrospectively collected,clinical data were obtained from electronic medical record(EMR),and the mammographic features of the patients were assessed by diagnostic physicians.The risk factors affecting the malignancy of amorphous calcifications were analyzed to develop a predictive model and to assess the performance of the model.Results A total of 153 amorphous calcifications in 144 patients were included in the study,and the overall malignancy rate of calcifications was 20.92％.Patient's age ≥45 years,linear distribution of calcifications,unilateral single or unilateral multiple calcifications,and a larger maximum ratio of calcification extent all predicted a higher probability of malignancy,establishing a nomogram based on these 4 risk factors,with a 3.65％predicted probability of malig-nancy as the cut-off,33.99％(52/153)of patients were allowed to be spared biopsy.Conclusion Patient's age and the distribution,number,and maximum ratio of calcifications may be the risk predictors of malignancy for amorphous calcifications,with nomogram con-struction for distinguishing benignity from malignancy of amorphous calcifications via combining with mammographic features and clinical data.

Objective:To systematically evaluate the risk of bias and applicability of risk prediction models for the progression of diabetic nephropathy (DN) .Methods:A systematic search was conducted in CNKI, CBMdisc, Wanfang, VIP, PubMed, Web of Science, Embase, and CINAHL for literature related to DN progression prediction models, with a search timeline up to April 30, 2023. Two researchers independently screened the literature and extracted data according to a checklist for key assessments of prediction model studies and the PROBAST tool for assessing risk of bias in prediction models.Results:A total of nine articles encompassing 15 models were included. Of these, eight studies were retrospective study, and one was a randomized controlled trial. The area under the receiver operating characteristic curve ( AUC) for these models ranged from 0.626 to 0.986. Three studies conducted external validation, and seven studies conducted internal validation. Commonly repeated predictive factors included eGFR, cystatin C, and glycated hemoglobin (HbA1c). While the overall applicability of the models was good, methodological issues such as inappropriate data acquisition, selection of predictive factors, and neglect of model performance evaluation contributed to a certain risk of bias. Conclusions:The current DN progression risk prediction models demonstrate good discrimination and applicability. However, most models lack comprehensive calibration assessments and exhibit methodological flaws. Future research should focus on developing models with better applicability and lower bias, coupled with effective internal and external validation.

Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) in reducing the incidence of nursing interruption with negative outcome in operating room, so as to maximize the smooth progress of the surgical process.Methods:This was a quasi experimental study. The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study. According to the surgical sequence, 38 surgeries performed in the gastrointestinal surgery suite from August 15-30, 2021 were set as the control group, and the conventional healthcare cooperation model process was implemented; 42 surgeries performed from September 15-30, 2021 were set as the intervention group, and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room, comparing the number, duration, source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results:In the control group, there were 38 observed surgeries, 190 negative outcome care interruptions, negative outcome interruptions of (5.26 ± 1.02) min duration, and no near misses; in the intervention group, there were 42 observed surgeries, 84 negative outcome care interruptions, negative outcome interruptions of (2.06 ± 0.08) min duration, and no near misses. There were statistically significant differences in the number, duration of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 18.71, t = - 20.28; all P<0.01). There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 12.71, P<0.01). Conclusions:HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room, shorten the duration of interruptions, and minimize potential safety hazards caused by nursing interruptions, which is conducive to ensuring the safety of patients.

Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.

Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.

Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.

Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.

Objective To explore the predictive significance of platelet changes on deep venous thrombosis of the lower limbs after total knee replacement,and to guide the early clinical prediction and prevent the occurrence of thrombotic events.Methods A retrospective study was conducted of the 50 patients who had been treated by total knee arthroplasty for degenerative knee osteoarthropathy from January 2016 to June 2018 in the Department of Orthopedics and Traumaology,Xi'an Jiangtong University Medical College Red Cross Hospital.There were 10 males and 40 females,aged from 47 to 80 years (average age 65.1 years).According to the results of B ultrasound examination of the lower extremities,the patients were divided into the non embolic group (24 cases) and the embolic group (26 cases).The platelet counts and hemoglobin levels of the two groups were recorded before and after operation,and their respective differences were calculated.The difference of hemoglobin difference between the two groups was analyzed.At the same time,the difference of platelet count and total knee joint were examined.Whether the deep venous thrombosis of the lower extremity after replacement was statistically significant.If there was no statistical difference in the difference in hemoglobin between the two groups,and the difference in platelet count was statistically significant,the ROC curve was made to determine the optimal screening point.If obeying the normal distribution and the homogeneity of the variance,an independent sample t test was performed on the platelet count difference and the hemoglobin amount difference between the two groups,and the dose data in accordance with the normal distribution was expressed as (Mean ±SD).Results The difference of platelet count was (30.4 ± 14.8) ×109/L in thrombosis group and (53.5 ± 15.2) × 109/L in thrombosis group.The difference of platelet count between the two groups had statistical significance (P ＜ 0.001).The best screening point of platelet count difference was 34.0 × 109/L.The difference of hemoglobin count between thrombosis group and thrombosis group was (20.8 ± 9.3) g/L and (24.0 ± 10.7) g/L,there was no significant difference in hemoglobin between the two groups (P ＞ 0.05).Conclusions Preoperative and postoperative platelet count difference can effectively predict the incidence of lower extremity deep venous thrombosis after total knee arthroplasty.When the platelet count difference before surgery ≥34.0 × 109/L,early prevention of deep venous thrombosis should be avoided.The formation of the occurrence.