Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective To explore the clinical efficacy and safety of single-port laparoscopic ovarian cyst removal surgery.Methods A total of 145 patients who underwent laparoscopic surgery for ovarian cyst in Wenzhou People's Hospital from January 2023 to June 2024.Among them,single-port laparoscopic ovarian cystectomy+oophoroplasty was performed in 67 cases as single-port group,and traditional multi-port laparoscopic ovarian cystectomy+oophoroplasty was performed in 78 cases as multi-port group.Clinical indicators during and after surgery in two groups were recorded and compared.Results There were significant difference the operation time and pain scores at 1 day after surgery between two groups(P＜0.05).There was no significant difference in intraoperative bleeding,postoperative exhaust time and postoperative hospitalization time between two groups(P＞0.05).Neither of two groups had intraoperative vascular or nerve damage in the abdominal wall,and there were no postoperative complications such as incision infection,intestinal obstruction,or lower limb venous thrombosis,and the incision healed well.Continuing the follow-up for 3 months after discharge,both surgical procedures had no significant effect on menstruation,and there was no short-term recurrence of ovarian cyst in either case.Conclusion The single-port laparoscopic technique for the treatment of ovarian cyst incision is concealed and beautiful,the postoperative pain is lighter.No obvious effect on menstruation,and the curative effect is definite and safe.

AIM:To optimize the clinical dosage and administration regimen of a novel long-acting injectable aripiprazole microsphere(LZMT05)using plasma concentration data from two clinical trials.METHODS:Plasma concentrations were collected from 196 schizophrenia patients administered LZMT05,and a population pharmacokinetic(Pop-PK)model was developed.The therapeutic window was defined as the steady-state trough-to-peak concentration range(94.0-534 ng/mL)of oral ar-ipiprazole.Multiple clinical scenarios were simulat-ed to identify the optimal regimen.RESULTS:A one-compartment model with dual first-order ab-sorption and first-order elimination characterized LZMT05 pharmacokinetics.Covariates like sex and CYP2D6 genotype were integrated into the final model.Simulations demonstrated that switching from 10 mg oral aripiprazole to 350 mg LZMT05 ev-ery 4 weeks sustained concentrations within the therapeutic window with minimal peak-to-trough fluctuations.CONCLUSION:The PopPK-guided opti-mized LZMT05 regimen maintained drug exposure within the therapeutic window,suggesting favor-able efficacy and safety.

Objective:To investigate impact of farrerol(Far)on LPS-induced microglial inflammatory injury by regulating cyclic guanosine monophosphate-adenosine monophosphate synthase(cGAS)-stimulator of interferon genes(STING)signal pathway.Methods:Mice BV2 microglial cell lines were grouped into control group(normal culture),LPS group(1 μg/ml),Far low,medium and high doses groups(1,5,10 μmol/L),activator group(10 μmol/L Far+75 μg/ml cGAS-STING signal pathway activator DMX-AA);proliferation and apoptosis of BV2 cells were detected by MTT,plate cloning assay and flow cytometry;qRT-PCR and ELISA were applied to detect levels of IL-6,IL-1β and TNF-α in cells and supernatants;NO content in cell supernatant was detected by nitrate reductase method;Western blot was applied to detect expressions of proliferating cell nuclear antigen(PCNA),Bcl-2 associated X protein(Bax),anti-apoptotic factor B cell lymphoma protein-2(Bcl-2)and cGAS-STING pathway protein in BV2 cells.Results:Compared with control group,A490 of BV2 cells,number of cloned cells,expressions of PCNA and Bcl-2 proteins in LPS group were decreased,apoptosis rate,mRNA expressions of IL-6,IL-1β,TNF-α,contents of IL-6,IL-1β,TNF-α,NO,and protein expres-sions of Bax,cGAS and STING were increased(P<0.05);compared with LPS group,A490 of BV2 cells,number of cloned cells,expressions of PCNA and Bcl-2 proteins in Far low,medium and high dose groups were increased,apoptosis rate,mRNA expressions of IL-6, IL-1β, TNF-α, contents of IL-6, IL-1β, TNF-α, NO, and protein expressions of Bax, cGAS and STING were decreased (P<0.05); compared with Far high-dose group, A490 of BV2 cells, number of cloned cells, expressions of PCNA and Bcl-2 proteins in activator group were decreased, apoptosis rate, mRNA expressions of IL-6, IL-1β, TNF-α, contents of IL-6, IL-1β, TNF-α, NO, and protein expressions of Bax, cGAS and STING were increased (P<0.05).Conclusion:Far may inhibit apoptosis and inflammatory injury of BV2 cells and promote proliferation of BV2 cells by inhibiting cGAS-STING pathway, and thus alleviate inflammatory injury of BV2 cells induced by LPS.

Objective:To investigate impact of farrerol(Far)on LPS-induced microglial inflammatory injury by regulating cyclic guanosine monophosphate-adenosine monophosphate synthase(cGAS)-stimulator of interferon genes(STING)signal pathway.Methods:Mice BV2 microglial cell lines were grouped into control group(normal culture),LPS group(1 μg/ml),Far low,medium and high doses groups(1,5,10 μmol/L),activator group(10 μmol/L Far+75 μg/ml cGAS-STING signal pathway activator DMX-AA);proliferation and apoptosis of BV2 cells were detected by MTT,plate cloning assay and flow cytometry;qRT-PCR and ELISA were applied to detect levels of IL-6,IL-1β and TNF-α in cells and supernatants;NO content in cell supernatant was detected by nitrate reductase method;Western blot was applied to detect expressions of proliferating cell nuclear antigen(PCNA),Bcl-2 associated X protein(Bax),anti-apoptotic factor B cell lymphoma protein-2(Bcl-2)and cGAS-STING pathway protein in BV2 cells.Results:Compared with control group,A490 of BV2 cells,number of cloned cells,expressions of PCNA and Bcl-2 proteins in LPS group were decreased,apoptosis rate,mRNA expressions of IL-6,IL-1β,TNF-α,contents of IL-6,IL-1β,TNF-α,NO,and protein expres-sions of Bax,cGAS and STING were increased(P<0.05);compared with LPS group,A490 of BV2 cells,number of cloned cells,expressions of PCNA and Bcl-2 proteins in Far low,medium and high dose groups were increased,apoptosis rate,mRNA expressions of IL-6, IL-1β, TNF-α, contents of IL-6, IL-1β, TNF-α, NO, and protein expressions of Bax, cGAS and STING were decreased (P<0.05); compared with Far high-dose group, A490 of BV2 cells, number of cloned cells, expressions of PCNA and Bcl-2 proteins in activator group were decreased, apoptosis rate, mRNA expressions of IL-6, IL-1β, TNF-α, contents of IL-6, IL-1β, TNF-α, NO, and protein expressions of Bax, cGAS and STING were increased (P<0.05).Conclusion:Far may inhibit apoptosis and inflammatory injury of BV2 cells and promote proliferation of BV2 cells by inhibiting cGAS-STING pathway, and thus alleviate inflammatory injury of BV2 cells induced by LPS.

AIM:To optimize the clinical dosage and administration regimen of a novel long-acting injectable aripiprazole microsphere(LZMT05)using plasma concentration data from two clinical trials.METHODS:Plasma concentrations were collected from 196 schizophrenia patients administered LZMT05,and a population pharmacokinetic(Pop-PK)model was developed.The therapeutic window was defined as the steady-state trough-to-peak concentration range(94.0-534 ng/mL)of oral ar-ipiprazole.Multiple clinical scenarios were simulat-ed to identify the optimal regimen.RESULTS:A one-compartment model with dual first-order ab-sorption and first-order elimination characterized LZMT05 pharmacokinetics.Covariates like sex and CYP2D6 genotype were integrated into the final model.Simulations demonstrated that switching from 10 mg oral aripiprazole to 350 mg LZMT05 ev-ery 4 weeks sustained concentrations within the therapeutic window with minimal peak-to-trough fluctuations.CONCLUSION:The PopPK-guided opti-mized LZMT05 regimen maintained drug exposure within the therapeutic window,suggesting favor-able efficacy and safety.

Objective To explore the clinical efficacy and safety of single-port laparoscopic ovarian cyst removal surgery.Methods A total of 145 patients who underwent laparoscopic surgery for ovarian cyst in Wenzhou People's Hospital from January 2023 to June 2024.Among them,single-port laparoscopic ovarian cystectomy+oophoroplasty was performed in 67 cases as single-port group,and traditional multi-port laparoscopic ovarian cystectomy+oophoroplasty was performed in 78 cases as multi-port group.Clinical indicators during and after surgery in two groups were recorded and compared.Results There were significant difference the operation time and pain scores at 1 day after surgery between two groups(P＜0.05).There was no significant difference in intraoperative bleeding,postoperative exhaust time and postoperative hospitalization time between two groups(P＞0.05).Neither of two groups had intraoperative vascular or nerve damage in the abdominal wall,and there were no postoperative complications such as incision infection,intestinal obstruction,or lower limb venous thrombosis,and the incision healed well.Continuing the follow-up for 3 months after discharge,both surgical procedures had no significant effect on menstruation,and there was no short-term recurrence of ovarian cyst in either case.Conclusion The single-port laparoscopic technique for the treatment of ovarian cyst incision is concealed and beautiful,the postoperative pain is lighter.No obvious effect on menstruation,and the curative effect is definite and safe.

Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

OBJECTIVE To predict the possible impact of pembrolizumab（PEM） as a first-line drug after being included in the national medical insurance system in the treatment of advanced or metastatic non-small cell lung cancer based on real-world data from the perspective of the national medical insurance payer， to provide a basis for the decision-making of the medical insurance department. METHODS A budget impact analysis model was constructed to compare the impact of pembrolizumab not included in medical insurance and included in medical insurance on medical insurance fund expenditure in the next five years（ 2024- 2028） with 2023 as the baseline year. The target population was the patients with EGFR gene mutation-negative and anaplastic lymphoma kinase （ALK）-negative locally advanced or metastatic non-small cell lung cancer； estimated cost mainly included the cost of drugs， the cost of adverse reaction treatment， the cost of examination， the cost of admission and monitoring， etc； equipment ratio of PEM in 183 hospitals of Guangdong province from 2020 to 2022 was used as the market share. Univariate sensitivity analysis was used to test the robustness of the basic analysis results. RESULTS When PEM was not included in the medical insurance， the medical insurance reimbursement amount of the target population from 2024 to 2028 was 4 933 623.5 thousand yuan-5 151 198.3 thousand yuan， respectively. If PEM was included in the medical insurance， the above data were 11 871 972.2 thousand yuan-14 540 571.0 thousand yuan， respectively； the increase in medical insurance reimbursement under the two scenarios was 6 720 773.9 thousand yuan-9 606 947.5 thousand yuan， respectively. The proportion of medical insurance reimbursement to the medical insurance expenditure of the year after PEM was included in medical insurance was 0.298 0%， 0.262 1%， 0.228 8%， 0.208 2%， and 0.185 7%， respectively. The increase in medical insurance reimbursement accounted for 1.084 0%， 0.995 7%， 0.888 6%， 0.886 3%， and 0.861 6% of the increase in the expenditure of the medical insurance fund in the current year， all of which showed a decreasing trend year by year. CONCLUSIONS If PEM is included in medical insurance， due to its high unit price， the medical expenditure will increase accordingly， which will have a great impact on the medical insurance fund expenditure. However， when the drug is used in patients with EGFR mutation-negative and ALK-negative locally advanced or metastatic non-small cell lung cancer， the proportion of the medical insurance reimbursement amount in the current year’s medical insurance fund expenditure and the proportion of the increase in medical insurance reimbursement in the current year’s increase in medical insurance fund expenditure are decreasing year by year.

Objective To explore the application value of stage rehabilitation intervention under the Health action process approach(HAPA)model(SRI-HAPAM)combined with tranexamic acid(TXA)in elderly patients with femoral neck fracture(FNF)undergoing total hip arthroplasty(THA).Methods Elderly FNF patients with unilateral THA in the First Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 were enrolled.According to the random number table method,the patients were divided into routine nursing(RN)group and TXA+SRI-HAPAM group.The RN group received conventional treatment after surgery,and the TXA+SRI-HAPAM group received TXA combined with SRI-HAPAM after surgery.The bleeding indexes[hidden blood loss(HBL),explicit blood loss(EBL)and blood transfusion volume(BTV)],and the levels of hemoglobin(Hb),C-reactive protein(CRP)and D-dimer(DD)were compared between the two groups at 24 h after surgery.The hip function[joint deformity(JD),joint function(JF),joint pain(JP),joint motion(JM)and total hip function(THF)],anxiety and depression[self-rating anxiety scale and self-rating depression scale],satisfaction with care,and complications were compared between the two groups at 3 months after surgery.Results A total of 100 elderly patients with unilateral THA due to FNF were included in the study,including 54 in the TXA+SRI-HAPAM group and 46 in the RN group.Before operation,there was no significant difference in Hb,CRP,DD,JD,JF,JP,JM,THF and SAS between the two groups(P>0.05).At 24 hours after operation,Hb decreased in the two groups,while CRP and DD increased(P<0.05),and the decrease in Hb and the increase in CRP and DD,as well as HBL,EBL and BTV in the TXA+SRI-HAPAM group,were lower than those in the RN group(P<0.05).At 3 months after operation,JD,JF,JP,JM and THF in both groups increased compared with those before operation,while SAS and SDS decreased compared with those before operation(P<0.05),and the functional scores of JD,JF,JP,JM and THF in the TXA+SRI-HAPAM group were significantly higher than those in the RN group,and the scores of SAS and SDS were lower than those in the RN group(P<0.05).3 months after surgery,the nursing satisfaction of the TXA+SRI-HAPAM group was significantly higher than that of the RN group,and the total complication rate was lower than that of the RN group(P<0.05).Conclusion Compared the Routine nursing,TXA combined with SRI-HAPAM more effectively promotes postoperative recovery in patients with THA.