Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis.Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023.Five patients were diagnosed and treated before 2020,while 47 were managed from 2020 onward.Patients were divided into two groups:a local debridement group(n=28)and an en bloc osteotomy group(n=24).Perioperative outcomes—including operative time,incision length,intraoperative blood loss,and length of hospital stay—were assessed,along with clinical efficacy at 6 months,12 months,and final follow-up.Clinical outcomes were evaluated using the Hospital for Special Surgery(HSS)knee score,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,joint range of motion(knee flexion-extension and ankle plantarflexion-dorsiflexion),recurrence rate,and the Paley classification for infectious bone defects.Results The local debridement group exhibited significantly less intraoperative blood loss(P<0.05),shorter operative time(P<0.05),and reduced hospital stay(P<0.05),as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively(P<0.05).In contrast,the osteotomy group demonstrated superior Paley classification outcomes at 6 months,12 months,and final follow-up(P<0.05),along with lower rates of infection recurrence.Longitudinal analysis indicated significant improvements in AOFAS scores,HSS scores,and joint mobility over time in both groups(P<0.05).However,no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up(P>0.05).Conclusion En bloc osteotomy combined with the induced membrane technique(Masquelet technique)enables more comprehensive debridement,minimizes the necessity for repeated surgical interventions,reduces postoperative complications,lowers the risk of recurrence,and promotes enhanced bone healing.

Objective:To assess the real-world triage performance of a dual-marker strategy (DMS) combining copeptin and high-sensitivity cardiac troponin T (hs-cTnT) in patients presenting with chest pain and suspected non-ST-segment elevation myocardial infarction (NSTEMI).Methods:It was conducted a prospective study of 277 consecutive chest pain patients admitted to the Emergency Department of Zhongshan Hospital, Fudan University, between July and August 2023. Admission levels of copeptin and hs-cTnT were measured. The safety, efficacy, and triage efficiency of the DMS (defined as copeptin <10 pmol/L and hs-cTnT <0.014 ng/mL) for excluding NSTEMI were evaluated based on final diagnoses and clinical outcomes.Results:Among 277 patients, 141 (50.9%) had cardiogenic diseases (51 NSTEMI, 37 unstable angina pectoris [UAP], 11 myocardial bridges, and 42 non-coronary artery disease), 29 (10.5%) had non-cardiac conditions, and 107 (38.6%) had low-risk chest pain of unknown etiology. A total of 103 patients (37.2%) were DMS-negative (copeptin and hs-cTnT both below cutoff), including 0 NSTEMI cases, 2 UAP cases, 1 myocardial bridge, 6 non-coronary artery diseases, 4 non-cardiac conditions, and 90 low-risk cases. The DMS demonstrated a negative predictive value (NPV) of 100% for excluding NSTEMI, with no major adverse cardiac events (MACE) observed in DMS-negative patients during 30-day follow-up. Real-world data revealed that only 42.2% of suspected NSTEMI patients received a second troponin test (timing: 1 hour—5.9%, 2 hours—23.9%, ≥3 hours—70.1%). The DMS enabled safe and efficient triage of 37.2% of chest pain patients at 0-hour, outperforming other strategies in applicability and feasibility ( P < 0.05). Conclusions:In real-world clinical practice, the DMS (copeptin combined with hs-cTnT) optimally complements guideline-recommended hs-cTnT algorithms. It provides a simple, rapid, and safe approach to managing acute chest pain, demonstrating superior applicability for improving emergency triage efficiency.

Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis.Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023.Five patients were diagnosed and treated before 2020,while 47 were managed from 2020 onward.Patients were divided into two groups:a local debridement group(n=28)and an en bloc osteotomy group(n=24).Perioperative outcomes—including operative time,incision length,intraoperative blood loss,and length of hospital stay—were assessed,along with clinical efficacy at 6 months,12 months,and final follow-up.Clinical outcomes were evaluated using the Hospital for Special Surgery(HSS)knee score,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,joint range of motion(knee flexion-extension and ankle plantarflexion-dorsiflexion),recurrence rate,and the Paley classification for infectious bone defects.Results The local debridement group exhibited significantly less intraoperative blood loss(P<0.05),shorter operative time(P<0.05),and reduced hospital stay(P<0.05),as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively(P<0.05).In contrast,the osteotomy group demonstrated superior Paley classification outcomes at 6 months,12 months,and final follow-up(P<0.05),along with lower rates of infection recurrence.Longitudinal analysis indicated significant improvements in AOFAS scores,HSS scores,and joint mobility over time in both groups(P<0.05).However,no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up(P>0.05).Conclusion En bloc osteotomy combined with the induced membrane technique(Masquelet technique)enables more comprehensive debridement,minimizes the necessity for repeated surgical interventions,reduces postoperative complications,lowers the risk of recurrence,and promotes enhanced bone healing.

Precancerous lesions of gastric cancer is a key stage in the development of gastric cancer.The reprogramming of glucose metabolism is a prominent feature of precancerous lesions of gastric cancer.Hypoxic microenvironment and hypoxia-inducible factors are important factors influencing the occurrence of glucose metabolic reprogramming.This article summarized the relationship between hypoxic microenvironment and the reprogramming of glucose metabolism in precancerous lesions of gastric cancer,and concluded the relevant research on TCM compounds and effective components to improve hypoxic microenvironment and further regulate glycolysis for the treatment of this disease.It was concluded that the mechanism may be the inhibition of angiogenesis,regulation of signaling pathways and key proteins of glycolysis,expression of multiple enzymes,reduction of lactate secretion,inhibition of cell malignant proliferation and invasion.It explored the mechanism of Chinese materia medica in improving hypoxic microenvironment and regulating glycolysis,so as to provide reference for the prevention and treatment of precancerous lesions of gastric cancer.

Objective:To investigate the clinical characteristics of patients with acute aortic dissection (AAD) through a retrospective and observational study, and to construct an early warning model of AAD that could be used in the emergency room.Methods:The data of 11 583 patients in the Emergency Chest Pain Center from January to December 2019 were retrospectively collected from the Chest Pain Database of Zhongshan Hospital Affiliated to Fudan University. Inclusion criteria: patients with chest pain who attended the Emergency Chest Pain Center between January and December 2019. Exclusion criteria were 1) younger than 18 years, 2) no chest/back pain, 3) patients with incomplete clinical information, and 4) patients with a previous definite diagnosis of aortic dissection who had or had not undergone surgery. The clinical data of 9668 patients with acute chest/back pain were finally collected, excluding 53 patients with previous definite diagnosis of AAD and/or without surgical aortic dissection. A total of 9 615 patients were enrolled as the modeling cohort for early diagnosis of AAD. The patients were divided into the AAD group and non-AAD group according to whether AAD was diagnosed. Risk factors were screened by univariate and multivariate logistic regression, the best fitting model was selected for inclusion in the study, and the early warning model was constructed and visualized based on the nomogram function in R software. The model performance was evaluated by accuracy, specificity, sensitivity, positive likelihood ratio and negative likelihood ratio. The model was validated by a validation cohort of 4808 patients who met the inclusion/exclusion criteria from January 2020 to June 2020 in the Emergency Chest Pain Center of the hospital. The effect of early diagnosis and early warning model was evaluated by calibration curve.Results:After multivariate analysis, the risk factors for AAD were male sex ( OR=0.241, P<0.001), cutting/tear-like pain ( OR=38.309, P<0.001), hypertension ( OR=1.943, P=0.007), high-risk medical history ( OR=12.773, P<0.001), high-risk signs ( OR=7.383, P=0.007), and the first D-dimer value ( OR=1.165, P<0.001), Protective factors include diabetes( OR=0.329, P=0.027) and coronary heart disease ( OR=0.121, P<0.001). The area under the ROC curve (AUC) of the early diagnosis and warning model constructed by combining the risk factors was 0.939(95 CI:0.909-0.969). Preliminary validation results showed that the AUC of the early diagnosis and warning model was 0.910(95 CI:0.870-0.949). Conclusions:Sex, cutting/tear-like pain, hypertension, high-risk medical history, high-risk signs, and first D-dimer value are independent risk factors for early diagnosis of AAD. The model constructed by these risk factors has a good effect on the early diagnosis and warning of AAD, which is helpful for the early clinical identification of AAD patients.

Objective:To evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

Objective:To investigate the differences in incidence of deep vein thrombosis (DVT) after closed fracture of lower extremity between patients with different blood types ABO.Methods:A retrospective study was conducted in the 1, 951 patients who had been admitted to Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University for lower extremity fractures from August 2014 to June 2018. They were 924 males and 1,027 females with a mean age of 63 (46, 78) years (range, from 16 to 102 years). Of them, 572 were type O, 564 type A, 609 type B and 206 type AB. Venous ultrasonography was performed on both lower extremities within 12 hours after admission. The incidences of DVT after fracture were compared between different blood types in all the patients, patients with proximal fracture of the knee, peri-knee fracture and distal fracture of the knee, and patients<60 years old and ≥60 years old.Results:The incidences of DVT were, respectively, 26.75% (153/572), 28.72% (162/564), 34.32% (209/609) and 29.61% (61/206) for patients with blood type O, type A, type B and type AB. The DVT incidence for type B was significantly higher than that for type O ( P< 0.008). The incidences of DVT were, respectively, 28.74% (98/341), 28.99% (100/345), 39.45% (144/365) and 30.97% (35/113) for blood type O, type A, type B and type AB in the patients with proximal fracture of the knee. The DVT incidence for blood type B was significantly higher than those for blood type O and blood type A ( P< 0.008). There were no significant differences in the DVT incidence between different blood types ABO in the patients with peri-knee fracture, distal fracture of the knee,<60 years old or ≥60 years old( P>0.05). The incidences of DVT were, respectively, 30.99% (97/313), 33.33% (108/324), 45.22% (156/345), 34.74% (33/95) for blood type O, type A, type B and type AB in the patients ≥60 years old. The DVT incidence for blood type B was significantly higher than those for blood type O and blood type A ( P< 0.008). Conclusions:The incidence of DVT varied with different blood types ABO after lower extremity fracture. The highest DVT incidence was found in patients with blood type B. The impact of blood type on the DVT incidence after lower extremity fracture was mainly observed in the patients with proximal fracture of the knee or an age of ≥ 60 years old.

Objective:To study the association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis (DVT) in patients with lower limb fracture.Methods:A retrospective study was performed of the 2, 482 patients with lower limb fracture who had been treated at Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2014 to August 2019. They were 1, 174 males and 1, 308 females with an age of (60.6±19.3) years. Recorded were the patients' age, gender, injury time, hemoglobin amount, D-dimer measurement, combined medical conditions, time and results of ultrasound vein examination on both lower extremities. According to the ultrasound results, the patients were divided into a thrombosis group and a thrombosis-free group. The 2 groups were compared in hemoglobin amount. Logistic regression was used to analyze the relationship between preoperative hemoglobin amount and incidence of lower limb DVT. The patients were divided into 5 groups according to the quintile of hemoglobin amount; the incidences of thrombosis were compared between the 5 groups.Results:The total incidence of DVT in this cohort was 29.53%(733/2, 482). The hemoglobin amount in the thrombosis group was (116.57±19.24) g/L, significantly lower than that in the thrombosis-free group (124.76±19.79) g/L ( P<0.05). The preoperative hemoglobin amount was a risk factor for incidence of DVT after a lower limb fracture ( OR=0.985, 95% CI: 0.980 to 0.990, P<0.001). As the quintile level of hemoglobin increased, the incidence of DVT showed a downward trend. In comparison of the group with the highest DVT incidence (40.58%) and the group with the lowest DVT incidence (17.27%), the risk increased by 2.386 times (95% CI: 1.718 to 3.315). Conclusions:The preoperative hemoglobin amount can affect the DVT incidence after a lower limb fracture, and a low hemoglobin amount may more likely lead to lower limb DVT.

Proteases are enzymes that cleave and hydrolyse the peptide bonds between two specific amino acid residues of target substrate proteins. Protease-controlled proteolysis plays a key role in the degradation and recycling of proteins, which is essential for various physiological processes. Thus, solving the substrate identification problem will have important implications for the precise understanding of functions and physiological roles of proteases, as well as for therapeutic target identification and pharmaceutical applicability. Consequently, there is a great demand for bioinformatics methods that can predict novel substrate cleavage events with high accuracy by utilizing both sequence and structural information. In this study, we present Procleave, a novel bioinformatics approach for predicting protease-specific substrates and specific cleavage sites by taking into account both their sequence and 3D structural information. Structural features of known cleavage sites were represented by discrete values using a LOWESS data-smoothing optimization method, which turned out to be critical for the performance of Procleave. The optimal approximations of all structural parameter values were encoded in a conditional random field (CRF) computational framework, alongside sequence and chemical group-based features. Here, we demonstrate the outstanding performance of Procleave through extensive benchmarking and independent tests. Procleave is capable of correctly identifying most cleavage sites in the case study. Importantly, when applied to the human structural proteome encompassing 17,628 protein structures, Procleave suggests a number of potential novel target substrates and their corresponding cleavage sites of different proteases. Procleave is implemented as a webserver and is freely accessible at http://procleave.erc.monash.edu/.

Objective:To compare the predictive value of the HEART, TIMI and GRACE scores for major adversecardiovascular events (MACEs) at 7 and 28 days in patients with actue non-ST-segment elevation myocardial infarction (NSTEMI).Methods:More than 12 000 patients with chest pain from the Emergency Department of Zhongshan Hospital Affiliated to Fudan University from October 2017 to October 2018 were studied, including 566 patients with cardiogenic chest pain, 105 patients with ST-segment elevation myocardial infarction (STEMI) excluded and 15 patients lost to follow-up. Finally, 109 patients with NSTEMI and 337 non-myocardial patients with cardiogenic chest pain were enrolled. NSTEMI patients were divided into subgroups according to whether MACEs occurred. LSD t-test, Mann-Whitney U test or χ2 test were used to analyze and compare the differences between the two subgroups about the baseline data, clinical data, HEART, TIMI and GRACE scores at the time of visit. Multivariate logistic regression analysis was used to explore the independent factors of MACEs at 7 and 28 days. And the predictive values of different scores for 7-day MACEs and 28-day MACEs were compared in NSTEMI patients through the receiver operating characteristic (ROC) curve. Results:Compared NSTEMI patients with non-myocardial patients with cardiogenic chest pain, we found a statistically significant differences in sex, past history of coronary heart disease,≥3 risk factors for atherosclerosis, electrocardiogram, high-sensitivity troponin T (hs-cTnT), creatinine value, past history of myocardial infarction, HEART score, TIMI score and GRACE score. In further subgroup analysis of NSTEMI patients who were divided according to whether MACEs occurred, we found previous history of stroke and increased hs-cTnT were statistically different in 7 days after the onset of the disease. The multivariate analysis showed that the previous history of stroke and increased hs-cTnT were independent factors for the occurrence of MACEs at 7 days after the onset of NSTEMI; The previous history of stroke and increased hs-cTnT, electrocardiogram ST segment depression and TIMI score were statistically different at 28 days after the onset of NSTEMI. The multivariate analysis showed that the previous history of stroke and TIMI score were independent factors for the occurrence of MACEs at 28 days after the onset of NSTEMI patients. ROC curve indicated that the predictive value of TIMI score (AUC=0.715, 95% CI: 0.482-0.948) was better than HEART (AUC=0.659, 95% CI: 0.414-0.904) and GRACE scores (AUC=0.587, 95% CI: 0.341-0.833)in predicting MACEs in NSTEMI patients. Conclusions:HEART score, TIMI score and GRACE score can be used to evaluate NSTEMI patients. There is an independent predictive value on TIMI score for the occurrence of 28-day MACEs in NSTEMI patients.