Fluorine, as one of the important trace elements, has multiple physiological functions and participates in body metabolism. Moderate intake of fluoride is beneficial for human health, while excessive fluoride can lead to dental fluorosis, skeletal fluorosis, and multi-organ damage. Typical symptoms of skeletal fluorosis include bone sclerosis, osteomalacia, osteoporosis, and degenerative changes in articular cartilage. The pathological basis for skeletal changes in fluorosis involves enhanced osteogenesis and accelerated bone turnover, which are comprehensively regulated by multiple signaling pathways. Although the etiology of skeletal fluorosis has been determined, its pathogenic mechanisms remain inconclusive. In recent years, researchers have extensively investigated the signaling pathways involved in skeletal fluorosis development, including Notch, phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), Wnt/β-catenin, Hedgehog, nuclear factor κB (NF-κB), parathyroid hormone (PTH), and insulin signaling pathways, as well as their interactive networks. This article summarizes and reviews the recent research findings, aiming to provide a theoretical foundation for comprehensively understanding the pathogenic mechanisms of skeletal fluorosis and offer insights for scientific prevention of skeletal fluorosis.

Fluorine, as one of the important trace elements, has multiple physiological functions and participates in body metabolism. Moderate intake of fluoride is beneficial for human health, while excessive fluoride can lead to dental fluorosis, skeletal fluorosis, and multi-organ damage. Typical symptoms of skeletal fluorosis include bone sclerosis, osteomalacia, osteoporosis, and degenerative changes in articular cartilage. The pathological basis for skeletal changes in fluorosis involves enhanced osteogenesis and accelerated bone turnover, which are comprehensively regulated by multiple signaling pathways. Although the etiology of skeletal fluorosis has been determined, its pathogenic mechanisms remain inconclusive. In recent years, researchers have extensively investigated the signaling pathways involved in skeletal fluorosis development, including Notch, phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), Wnt/β-catenin, Hedgehog, nuclear factor κB (NF-κB), parathyroid hormone (PTH), and insulin signaling pathways, as well as their interactive networks. This article summarizes and reviews the recent research findings, aiming to provide a theoretical foundation for comprehensively understanding the pathogenic mechanisms of skeletal fluorosis and offer insights for scientific prevention of skeletal fluorosis.

Objective: To analyze the characteristics of school injury among students aged 3 to 18 years in Yantian District of Shenzhen City, Guangdong Province, so as to provide the reference for developing the strategies for prevention and control of school injury. Methods: Data of the students aged 3 to 18 years who were initially diagnosed as injury in sentinel hospitals and whose injuries occurred in nurseries, primary or middle schools in Yantian District in 2023, were collected from the Shenzhen Injury Surveillance System. The onset time, places, activities, characteristics and sites of injury were descriptively analyzed. Results: A total of 1 681 cases of school injuries among students aged 3 to 18 years were reported in Yantian District in 2023, including 1 182 boys and 499 girls, with a boy-to-girl ratio of 2.37∶1. There were 206 preschool children (12.25%), 856 primary school students (50.92%), 358 junior high school students (21.30%) and 261 high school students (15.53%). The peak months for school injuries were February to June, accounting for 49.97%; the peak time period was from 15: 00 to 18: 59, accounting for 44.68%. The main causes of injuries included falls (41.94%) and blunt injury (33.85%). The activities at the time of injury mainly included leisure activities (57.70%) and physical activities (21.83%). Contusion/abrasion was the main characteristics (49.20%). Mild injury was predominant, accounting for 74.60%, and there was no fatal case. The top three injury sites were the head and neck, upper limbs and lower limbs, accounting for 36.94%, 27.54%, and 24.33%, respectively. Boys had higher proportions of blunt injuries and contusion/abrasion (AR=4.8 and 4.0). The proportion of sports injuries, sprains/strains and lower limb injuries increased with grade (all P<0.05). Conclusions School injury among students predominantly occur in spring when having leisure or physical activities in Yantian District. The main causes of injuries are falls and blunt injury, with boys and primary school students being the high-risk groups.

OBJECTIVE: To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. METHODS: A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. RESULTS: The wound area was 21.0-180.0 cm ² (mean, 57.82 cm ²) before operation, and it was 1.2-27.0 cm ² (mean, 6.57 cm ²) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). CONCLUSION Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cicatrix ; Retrospective Studies ; Treatment Outcome ; Tibial Fractures/surgery* ; Wound Healing ; Fracture Fixation, Internal/methods* ; Fractures, Open/surgery*

ObjectiveTo investigate the role and mechanism of DNA repair regulation in the process of hepatocellular carcinoma （HCC） recurrence. MethodsHCC tissue samples were collected from the patients with recurrence within two years or the patients with a good prognosis after 5 years， and the Tandem Mass Tag-labeled quantification proteomic study was used to analyze the differentially expressed proteins enriched in the four pathways of DNA replication， mismatch repair， base excision repair， and nucleotide excision repair， and the regulatory pathways and targets that play a key role in the process of HCC recurrence were analyzed to predict the possible regulatory mechanisms. The independent samples t-test was used for comparison of continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsFor the eukaryotic replication complex pathway， there were significant reductions in the protein expression levels of MCM2 （P=0.018）， MCM3 （P=0.047）， MCM4 （P=0.014）， MCM5 （P=0.008）， MCM6 （P=0.006）， MCM7 （P=0.007）， PCNA （P=0.019）， RFC4 （P=0.002）， RFC5 （P<0.001）， and LIG1 （P=0.042）； for the nucleotide excision repair pathway， there were significant reductions in the protein expression levels of PCNA （P=0.019）， RFC4 （P=0.002）， RFC5 （P<0.001）， and LIG1 （P=0.042）； for the base excision repair pathway， there were significant reductions in the protein expression levels of PCNA （P=0.019） and LIG1 （P=0.042） in the HCC recurrence group； for the mismatch repair pathway， there were significant reductions in the protein expression levels of MSH2 （P=0.026）， MSH6 （P=0.006）， RFC4 （P=0.002）， RFC5 （P<0.001）， PCNA （P=0.019）， and LIG1 （P=0.042） in recurrent HCC tissue. The differentially expressed proteins were involved in the important components of MCM complex， DNA polymerase complex， ligase LIG1， long patch base shear repair complex （long patch BER）， and DNA mismatch repair protein complex. The clinical sample validation analysis of important differentially expressed proteins regulated by DNA repair showed that except for MCM6 with a trend of reduction， the recurrence group also had significant reductions in the relative protein expression levels of MCM5 （P=0.008）， MCM7 （P=0.007）， RCF4 （P=0.002）， RCF5 （P<0.001）， and MSH6 （P=0.006）. ConclusionThere are significant reductions or deletions of multiple complex protein components in the process of DNA repair during HCC recurrence.

To investigate the safety and feasibility of gasless total endoscopic resection of deep lobe parotid gland tumors via a postauricular hairline plus temporal approach. The approach was designed as: a 4 to 5 cm main incision was designed at the postauricular hairline, and a 0.5 cm auxiliary incision was designed in the temporal hairline. The operating cavity was established with the assistance of a special retractor. "Anterograde" dissection of the facial nerve was performed throughout the procedure, along with partial or total gland removal of the tumor. All 16 operations were successfully completed without conversion to open surgery. During the operation, the trunk and branches of the facial nerve were completely preserved, the tumor was completely removed, and the incision healed. Six patients had mild facial paralysis after operation, and recovered completely after 3 to 6 months. There was no salivary fistula, Frey syndrome, infection, or other complications. The postoperative incision was concealed and the aesthetic effect was good. The postauricular hairline plus temporal approach gasless total endoscopic parotidectomy is safe and feasible. This technique can achieve the complete dissection of the total trunk to the branches of the facial nerve, and has good access to the tumors located in any part of the parotid gland region. On the basis of radical resection of the tumor, it achieves minimally invasive and aesthetic improvement.

Objective:To investigate the outcomes of periacetabular osteotomy (PAO) through modified Smith-Petersen or Bikini approach with an auxiliary posterolateral incision for developmental dysplasia of hip (DDH).Methods:85 patients (97 hips) who underwent PAO through modified Smith-Petersen or Bikini approach with auxiliary posterolateral incision for DDH in the 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army or the Second Xiangya Hospital of Central South University from January 2016 to January 2021 were retrospectively analyzed. There were 70 females and 15 males, with an average age of 28.6±8.4 years (12-49). According to the Hartofilakidis classification, all patients were classified as type Ⅰ. There were 77 hips classified as Grade 0 and 20 hips classified as Grade 1 according to the T?nnis classification. The X-ray evaluation including the lateral central edge angle (LCEA), t?nnis angle (TNS) and anterior central edge angle (ACEA), visual analogue score (VAS) and modified Harries hip score (mHHS) were recorded preoperatively and during each postoperative follow-up. The cumulative sum (CUSUM) method was used to fit the learning curves of operation time.Results:All patients were followed-up with an average of 52.7±18.9 months (21 to 84). The average operative time and intraoperative blood loss were 95.9±28.2 min (65 to 215) and 414.7±97.0 ml (250 to 900), respectively. The learning curve of operation time was 10 cases. The average LCEA 32.39° (30.29°, 34.92°), TNS 3.14° (1.56°, 5.67°) and ACEA 31.55° (29.07°, 33.88°) were all significantly improved compared to preoperative values ( Z=-30.764, P<0.001; Z=30.595, P<0.001; Z=-38.134, P<0.001). The average VAS was reduced from 5.18±0.88 points preoperatively to 1.27±0.93 points postoperatively with significant difference ( t=51.231, P<0.001). The average mHHS was increased from 73.12±9.17 to 92.02±4.05 postoperatively with significant difference ( t=-26.902, P<0.001). No patients received total hip arthroplasty during the follow-up period. Conclusion:Bernese PAO through modified Smith-Petersen or Bikini approach with a small auxiliary posterolateral incision was not only a safe and effective method for the treatment of DDH but also shortened the learning curve and reduced difficulty of the surgery.

Objective:To investigate the protective effect of external diaphragm pacing（EDP）combined with hyperbaric oxygen（HBO）therapy on preventing ventilator-induced diaphragm dysfunction（VIDD）and its related mechanism.Methods:A total of 100 adult male rats were randomly divided into five groups：blank control（BC）group，VIDD group，EDP group，HBO therapy group，and the combination of EDP and HBO therapy（EDP+HBO）group，with 20 rats per group. After tracheotomy，the BC group received no treatment，while the rats in the other four groups were given controlled mechanical ventilation to establish the VIDD rat model. And after successful modeling，the VIDD group did not receive further intervention，and the other three groups were treated accordingly. After 10 days of consecutive treatment，the changes in diaphragm weight（DW）and DW/body weight（BW），contraction force of diaphragm in vitro，and transection area of muscle fibers of each group were measured. Gene and protein expressions of diaphragm-related factors were detected. Results:Compared with the BC group，the DW，DW/BW，the transection area of muscle fibers，and the fiber structure and the contraction force of diaphragm in vitro of the VIDD group were decreased significantly. The expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1 in the VIDD group were significantly increased while the expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px were significantly decreased after treatment（ P < 0.05）. Compared with the VIDD group，the EDP+HBO group had higher DW and DW/BW［（0.35 ± 0.02）g vs.（0.63 ± 0.06）g，0.78 ± 0.08 vs. 1.34 ± 0.06，both P<0.05］，stronger contraction force of diaphragm in vitro［（1.15 ± 0.42）N/cm 2vs.（2.19 ± 0.10）N/cm 2， P < 0.05］，declining expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1，increased expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px，and much better diaphragmatic function，and all the differences were statistically significant（ P<0.05）. Conclusion:External diaphragm pacing combined with HBO therapy can significantly mitigate and decelerate VIDD by increasing the contraction force of the diaphragm，and reducing the oxidative stress，diaphragmatic atrophy and structural injury.

Objective:To investigate the protective effect of external diaphragm pacing（EDP）combined with hyperbaric oxygen（HBO）therapy on preventing ventilator-induced diaphragm dysfunction（VIDD）and its related mechanism.Methods:A total of 100 adult male rats were randomly divided into five groups：blank control（BC）group，VIDD group，EDP group，HBO therapy group，and the combination of EDP and HBO therapy（EDP+HBO）group，with 20 rats per group. After tracheotomy，the BC group received no treatment，while the rats in the other four groups were given controlled mechanical ventilation to establish the VIDD rat model. And after successful modeling，the VIDD group did not receive further intervention，and the other three groups were treated accordingly. After 10 days of consecutive treatment，the changes in diaphragm weight（DW）and DW/body weight（BW），contraction force of diaphragm in vitro，and transection area of muscle fibers of each group were measured. Gene and protein expressions of diaphragm-related factors were detected. Results:Compared with the BC group，the DW，DW/BW，the transection area of muscle fibers，and the fiber structure and the contraction force of diaphragm in vitro of the VIDD group were decreased significantly. The expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1 in the VIDD group were significantly increased while the expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px were significantly decreased after treatment（ P < 0.05）. Compared with the VIDD group，the EDP+HBO group had higher DW and DW/BW［（0.35 ± 0.02）g vs.（0.63 ± 0.06）g，0.78 ± 0.08 vs. 1.34 ± 0.06，both P<0.05］，stronger contraction force of diaphragm in vitro［（1.15 ± 0.42）N/cm 2vs.（2.19 ± 0.10）N/cm 2， P < 0.05］，declining expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1，increased expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px，and much better diaphragmatic function，and all the differences were statistically significant（ P<0.05）. Conclusion:External diaphragm pacing combined with HBO therapy can significantly mitigate and decelerate VIDD by increasing the contraction force of the diaphragm，and reducing the oxidative stress，diaphragmatic atrophy and structural injury.

ViewRay magnetic resonance (MR) guided radiotherapy system not only solves the problem of imaging dose,but also can set up accurately,online adaptive radiotherapy and gated irradiation according to magnetic resonance imaging (MRI).The development of this system provides a new technical means of accurate radiotherapy.This review describes the main structure of the ViewRay system,and summarizes quality assurance (QA),dosimetric comparison,respiratory motion management,online adaptive radiotherapy,and preliminary treatment effect.