Objective To compare perinatal characteristics between single and twin pregnancies achieved through in vitro fertilization(IVF)versus those conceived naturally,and to evaluate their impact on pregnancy outcomes.Methods A total of 32901 women who delivered at Jinhua People's Hospital from January 2016 to December 2023 were enrolled.Participants were divided into four groups based on conception methods:IVF single pregnancy group(n=920),natural conception single pregnancy group(n=31 170),IVF twin pregnancy group(n=347),and natural conception twin pregnancy group(n=464).Multivariate Logistic regression analysis was employed to assess the effects of different conception methods on perinatal characteristics and pregnancy outcomes.Results Logistic regression analysis revealed that compared with the naturally conceived singleton group,advanced maternal age,gestational diabetes,hypothyroidism,preterm rupture of membranes,preterm birth,uterine atony,and hospitalization duration＞7d factors in IVF singleton group such as were associated with pregnancy outcomes(P＜0.05).Compared with naturally conceived twin group,IVF twin group showed correlations between intrahepatic cholestasis of pregnancy,preterm rupture of membranes,preterm birth,and pregnancy outcomes(P＜0.05).Conclusion IVF technology not only increases the proportion of twin pregnancies,but also significantly increases the risk of perinatal complications.Clinical management of IVF pregnancies requires closer monitoring and highly individualized perinatal care plans.

Objective To investigate the relationship between polymorphisms at the rs3093030 and rs5498 loci of the intercellular adhesion molecule-1(ICAM-1)gene in combination with high sensitive C-reactive protein(hs-CRP)and susceptibility to type 2 diabetes mellitus complicated with HTN(T2MH)susceptibility.Methods 200 newly diagnosed T2DM patients,175 T2MH patients and 200 healthy controls from Affiliated Hospital of Guilin Medical University between September 2021 and January 2022.Single nucleotide polymorphisms(SNP)-scan high-throughput technology was used to detect the genotyping of serum rs3093030 and rs5498 polymorphisms in the study subjects and to detect hs-CRP levels in peripheral plasma to analysed and explore the correlation between them and the development of T2MH.Results The peripheral blood hs-CRP expression level of patients in the T2MH group[2.65(1.18,6.50)mg/L]was significantly higher than that in the T2DM group[1.82(0.80,4.48)mg/L]and healthy controls[1.02(0.54,2.29)mg/L],and the differences were statistically significant(Z=-2.729,-7.132,all P<0.001).After population classification by genotype,it was found that compared with healthy controls,rs3093030 CC(Z=-3.912,-5.800),rs5498 AA(Z=-3.293,-4.944)and AG(Z=-3.275,-4.872)genotypes had significantly higher hs-CRP levels.The peripheral blood hs-CRP levels of patients with rs3093030 CT genotype in the T2MH group were significantly higher than that of healthy controls(Z=-3.987),and the differences was statistically significant(all P<0.001),respectively.Meanwhile,regression analysis showed that HS-CRP was a risk factor for both T2MH group and healthy control group(OR=1.181,95%CI=1.095～1.274,P<0.001).Conclusion There is a correlation between ICAM-1 gene rs3093030 and rs5498 polymorphisms combined with hs-CRP levels in peripheral blood and the pathogenesis of T2MH patients.

Objective To investigate the relationship between polymorphisms at the rs3093030 and rs5498 loci of the intercellular adhesion molecule-1(ICAM-1)gene in combination with high sensitive C-reactive protein(hs-CRP)and susceptibility to type 2 diabetes mellitus complicated with HTN(T2MH)susceptibility.Methods 200 newly diagnosed T2DM patients,175 T2MH patients and 200 healthy controls from Affiliated Hospital of Guilin Medical University between September 2021 and January 2022.Single nucleotide polymorphisms(SNP)-scan high-throughput technology was used to detect the genotyping of serum rs3093030 and rs5498 polymorphisms in the study subjects and to detect hs-CRP levels in peripheral plasma to analysed and explore the correlation between them and the development of T2MH.Results The peripheral blood hs-CRP expression level of patients in the T2MH group[2.65(1.18,6.50)mg/L]was significantly higher than that in the T2DM group[1.82(0.80,4.48)mg/L]and healthy controls[1.02(0.54,2.29)mg/L],and the differences were statistically significant(Z=-2.729,-7.132,all P<0.001).After population classification by genotype,it was found that compared with healthy controls,rs3093030 CC(Z=-3.912,-5.800),rs5498 AA(Z=-3.293,-4.944)and AG(Z=-3.275,-4.872)genotypes had significantly higher hs-CRP levels.The peripheral blood hs-CRP levels of patients with rs3093030 CT genotype in the T2MH group were significantly higher than that of healthy controls(Z=-3.987),and the differences was statistically significant(all P<0.001),respectively.Meanwhile,regression analysis showed that HS-CRP was a risk factor for both T2MH group and healthy control group(OR=1.181,95%CI=1.095～1.274,P<0.001).Conclusion There is a correlation between ICAM-1 gene rs3093030 and rs5498 polymorphisms combined with hs-CRP levels in peripheral blood and the pathogenesis of T2MH patients.

Objective To compare perinatal characteristics between single and twin pregnancies achieved through in vitro fertilization(IVF)versus those conceived naturally,and to evaluate their impact on pregnancy outcomes.Methods A total of 32901 women who delivered at Jinhua People's Hospital from January 2016 to December 2023 were enrolled.Participants were divided into four groups based on conception methods:IVF single pregnancy group(n=920),natural conception single pregnancy group(n=31 170),IVF twin pregnancy group(n=347),and natural conception twin pregnancy group(n=464).Multivariate Logistic regression analysis was employed to assess the effects of different conception methods on perinatal characteristics and pregnancy outcomes.Results Logistic regression analysis revealed that compared with the naturally conceived singleton group,advanced maternal age,gestational diabetes,hypothyroidism,preterm rupture of membranes,preterm birth,uterine atony,and hospitalization duration＞7d factors in IVF singleton group such as were associated with pregnancy outcomes(P＜0.05).Compared with naturally conceived twin group,IVF twin group showed correlations between intrahepatic cholestasis of pregnancy,preterm rupture of membranes,preterm birth,and pregnancy outcomes(P＜0.05).Conclusion IVF technology not only increases the proportion of twin pregnancies,but also significantly increases the risk of perinatal complications.Clinical management of IVF pregnancies requires closer monitoring and highly individualized perinatal care plans.

Objective:To compare the clinical efficacy of using micro steel plate internal fixation through the lateral elbow joint approach and traditional posterior olecranon osteotomy approach for the treatment of Dubberley 3B distal humeral coronal fracture.Method:A retrospective analysis was conducted on the data of 35 patients with Dubberley 3B distal humeral coronal fractures admitted to the Orthopedics Department of Jingmen Central Hospital (15 cases) and the Central Theater Command General Hospital of the People's Liberation Army (20 cases) from January 2018 to May 2023. Among them, 23 cases were treated with micro steel plate internal fixation through the lateral elbow joint approach (study group), and 12 cases were treated with traditional posterior olecranon osteotomy approach internal fixation (control group). There were 24 males and 11 females aging from 32 to 64 years old with 18 left elbows and 17 right ones. All of them were fresh fracture cases. The surgical incision length, surgical time, intraoperative bleeding, hospital stay, fracture healing, and incidence of complications between the two groups were recorded and compared. Visual analog scale (VAS) was recorded at 1 week and 1 month after surgery. Function recovery was assessed using Mayo elbow joint function score (Mayo elbow performance score, MEPS) at 3 months and the last follow-up.Result:There was no significant difference in preoperative baseline data between the study group and control group ( P>0.05). Patients in the study group were followed up for 18.7±3.9 months (range 12-47 months) while those in the control group were followed up for 22.3±4.7 months (range 12-52 months). There were significant differences between the study group and control group in the surgical incision length (10.5±0.9 cm vs. 21.2±1.7 cm), surgical time (76.3±4.7 min vs. 98.8±6.1 min), intraoperative blood loss (65.6±10.2 vs. 148.5±14.9 ml), length of stay( 10.4±1.5 vs. 15.8±1.6 d), and fracture healing time (4.2±0.9 months vs. 5.7±1.1 months) ( P<0.05). At the follow-up of 1 week and 1 month, the VAS of the study group (2.7±0.4, 1.3±0.4) were significantly lower compared to the control group ( 3.1±0.5, 1.8±0.6), ( t=2.577, 2.288; P=0.015, 0.029). At the follow up of 3 months, the MEPS of the study group were significantly higher compared to the control group (83.6±1.7 vs. 60.3±4.2, t=23.418, P<0.001). With time, the VAS of both groups decreased significantly, and the MEPS increased significantly ( P<0.05). At the last follow-up, there was no significant difference in MEPS between the two groups (92.3±3.8 vs. 89.5±5.7, P>0.05). At the last follow-up, there were 3 cases of joint degeneration in the study group with no complications of nerve or vascular damage, screw cutting, nonunion of fractures, loss of reduction, joint stiffness, or ectopic ossification, while in the control group, there was one case of delayed healing at the olecranon osteotomy site, one case of poor reduction of the fracture, both treated with immobilization and showing varying degrees of joint stiffness; one case showed ectopic ossification, and a total of four patients experienced elbow joint stiffness. The incidence of complications between the two groups [13.0% (3/23) vs. 33.3% (4/12)] showed significant difference ( P<0.05). Conclusion:The treatment of Dubberley 3B distal humeral coronal fracture through the lateral approach of elbow joint with mini steel plate internal fixation yielded good clinical results with the advantages of short surgical time, reliable internal fixation, satisfying joint function and fewer complications.

Objective:To compare the clinical efficacy of using micro steel plate internal fixation through the lateral elbow joint approach and traditional posterior olecranon osteotomy approach for the treatment of Dubberley 3B distal humeral coronal fracture.Method:A retrospective analysis was conducted on the data of 35 patients with Dubberley 3B distal humeral coronal fractures admitted to the Orthopedics Department of Jingmen Central Hospital (15 cases) and the Central Theater Command General Hospital of the People's Liberation Army (20 cases) from January 2018 to May 2023. Among them, 23 cases were treated with micro steel plate internal fixation through the lateral elbow joint approach (study group), and 12 cases were treated with traditional posterior olecranon osteotomy approach internal fixation (control group). There were 24 males and 11 females aging from 32 to 64 years old with 18 left elbows and 17 right ones. All of them were fresh fracture cases. The surgical incision length, surgical time, intraoperative bleeding, hospital stay, fracture healing, and incidence of complications between the two groups were recorded and compared. Visual analog scale (VAS) was recorded at 1 week and 1 month after surgery. Function recovery was assessed using Mayo elbow joint function score (Mayo elbow performance score, MEPS) at 3 months and the last follow-up.Result:There was no significant difference in preoperative baseline data between the study group and control group ( P>0.05). Patients in the study group were followed up for 18.7±3.9 months (range 12-47 months) while those in the control group were followed up for 22.3±4.7 months (range 12-52 months). There were significant differences between the study group and control group in the surgical incision length (10.5±0.9 cm vs. 21.2±1.7 cm), surgical time (76.3±4.7 min vs. 98.8±6.1 min), intraoperative blood loss (65.6±10.2 vs. 148.5±14.9 ml), length of stay( 10.4±1.5 vs. 15.8±1.6 d), and fracture healing time (4.2±0.9 months vs. 5.7±1.1 months) ( P<0.05). At the follow-up of 1 week and 1 month, the VAS of the study group (2.7±0.4, 1.3±0.4) were significantly lower compared to the control group ( 3.1±0.5, 1.8±0.6), ( t=2.577, 2.288; P=0.015, 0.029). At the follow up of 3 months, the MEPS of the study group were significantly higher compared to the control group (83.6±1.7 vs. 60.3±4.2, t=23.418, P<0.001). With time, the VAS of both groups decreased significantly, and the MEPS increased significantly ( P<0.05). At the last follow-up, there was no significant difference in MEPS between the two groups (92.3±3.8 vs. 89.5±5.7, P>0.05). At the last follow-up, there were 3 cases of joint degeneration in the study group with no complications of nerve or vascular damage, screw cutting, nonunion of fractures, loss of reduction, joint stiffness, or ectopic ossification, while in the control group, there was one case of delayed healing at the olecranon osteotomy site, one case of poor reduction of the fracture, both treated with immobilization and showing varying degrees of joint stiffness; one case showed ectopic ossification, and a total of four patients experienced elbow joint stiffness. The incidence of complications between the two groups [13.0% (3/23) vs. 33.3% (4/12)] showed significant difference ( P<0.05). Conclusion:The treatment of Dubberley 3B distal humeral coronal fracture through the lateral approach of elbow joint with mini steel plate internal fixation yielded good clinical results with the advantages of short surgical time, reliable internal fixation, satisfying joint function and fewer complications.

Objective:To compare closed reduction and intramedullary nailing versus open reduction and locking plate fixation in the treatment of middle and upper humeral fractures.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with middle and upper humeral fracture who had been treated at Department of Orthopaedics, The First People's Hospital of Jinmen and at Department of Orthopedics, General Hospital of PLA Central Theater from October 2017 to February 2021. There were 35 males and 27 females, aged from 27 to 86 years. The left side was affected in 24 cases and the right side in 38 cases. All fractures were fresh. According to the AO classification, 16 cases were type A, 32 type B, and 14 type C. Of the patients, 29 were treated with closed reduction and intramedullary nailing (intramedullary nail group) and 33 with open reduction and locking plate fixation (locking plate group). The length of incision, operation time, intraoperative blood loss, hospital stay, fracture healing and complications were recorded and compared between the 2 groups. The pain degree was evaluated by visual analogue scale (VAS) at one week and one month after operation, and the functional recovery of the shoulder was evaluated by Constant-Murley score at one month and 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The intramedullary nail group was followed up for 12 to 29 months and the locking plate group for 15 to 50 months. In the intramedullary nail group, the length of incision [(4.1±0.7) cm], operation time [(58.3±7.7) min], intraoperative blood loss [(52.7±6.5) mL], and hospital stay [(7.3±1.5) d] were significantly less than those in the locking plate group [(21.7±2.3) cm, (95.8±11.7) min, (237.4±14.9) ml, and (12.3±1.7) d] ( P<0.05). The fracture healing time in the intramedullary nail group was (5.0±1.9) months, significantly longer than that in the locking plate group [(3.5±1.7) months] ( P<0.05). The VAS scores at one week and one month after operation in the intramedullary nail group [(2.8±0.3) points and (1.2±0.5) points] were significantly lower than those in the locking plate group [(4.3±0.4) points and (1.6±0.5) points], and the Constant-Murley score at one month after operation in the intramedullary nail group [(63.5±7.4) points] was significantly higher than that in the locking plate group [(54.3±6.9) points] ( P<0.05). However, at 12 months after operation, there was no significant difference in the Constant-Murley score between the 2 groups ( P>0.05). In both groups, the VAS score at one month after operation was significantly lower than that at one week after operation while the Constant-Murley score at 12 months after operation was significantly higher than that at one week after operation ( P<0.05). In the intramedullary nail group, intraoperative distal refracture happened in one case; in the locking plate group, incision infection occurred in one case and postoperative radial nerve injury in another. There was no significant difference in the incidence of complications between the 2 groups [3.4% (1/29) versus 6.1% (2/33)] ( P>0.05). Conclusion:In the treatment of middle and upper humeral fractures, compared with open reduction and locking plate fixation, closed reduction and intramedullary nailing shows advantages of a smaller surgical incision, shorter operation time, less intraoperative blood loss, shorter hospital stay and faster functional recovery.

Objective:To investigate the clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture.Methods:The data of 26 patients treated with fibular fracture line from January 2017 to July 2019 were analyzed retrospectively, including 11 males and 15 females; the age ranged from 28 to 69 years, with an average of 42.2 years. There were 10 cases of falling injury, 9 cases of falling injury and 7 cases of traffic injury; all of them were fresh closed fibular fractures;According to Yu Guangrong's classification, there were 11 cases of type I, 8 cases of type II and 7 cases of type III; AGH was divided into 10 cases of type I, 5 cases of type IIa, 2 cases of type IIb, 5 cases of type IIIa and 4 cases of type IIIb. All cases were treated by opening the fibular fracture line through the posterolateral approach, the quality of fracture reduction was evaluated by Burwell Charnley radiological evaluation standard after operation; At the last follow-up, ankle function was evaluated by American Association of Foot and Ankle surgery (AOFAS) ankle and hindfoot scores.Results:All 26 patients were followed up for 12-23 months, with an average of 14.9 months; Bone healing was achieved in all fractures. The healing time was 3-6 months, with an average of 4.0 months. The quality of fracture reduction was evaluated according to the Burwell Charnley radiology evaluation standard after operation, including anatomical reduction in 23 cases and acceptable reduction in 3 cases. The anatomical reduction rate was 88% (23/26). At the last follow-up, AOFAS ankle and hindfoot scores ranged from 80 to 100, with an average of 89.9 points, of which 17 cases were excellent and 9 cases were good, and the excellent and good rate was 100%. At the last follow-up, no patient had complications such as reduction loss, skin necrosis, infection, internal fixation loosening or ankle stiffness.Conclusion:After the treatment of Pilon fractures via peroneal fracture line, the distal tibial articular surface and posterior ankle fracture gap can be fully exposed, which can be repositioned and fixed under direct vision, with high anatomical repositioning rate and good and safe clinical results.

Objective:To compare the effect of interlocking intramedullary nail and locking plate in the treatment of varus proximal humeral fractures in the elderly.Method:A retrospective case-control study was conducted to analyze the clinical data of 46 elderly patients with varus proximal humeral fractures treated in Central Theater General Hospital of PLA from June 2016 to January 2019, including 27 males and 19 females, at age of 60-84 years［（71.9±5.7）years］. All fractures were fresh. Overall 25 patients were treated with interlocking intramedullary nail（intramedullary nail group）, and 21 patients were treated with locking plate（bone plate group）. The incision length, operation time, intraoperative bleeding and fracture healing time were compared between the two groups. Visual analogue scale（VAS）was used to evaluate the degree of pain relief at 1 week and 1 month after operation, and Constant-Murley score was used to evaluate the recovery of shoulder function at 1 month, 3 months and 1 year after operation. The cervical trunk angle was recorded at 2 days and 1 year after operation to judge whether there was a loss of cervical trunk angle. Postoperative complications were observed.Results:All patients were followed up for 12-32 months［（19.7±6.6）months］. The incision length［（7.1±0.6）cm］, operation time［（60.8±5.2）minutes］, intraoperative bleeding［（64.4±8.4）ml］and fracture healing time［（10.0±1.0）weeks］in intramedullary nail group were significantly less than those in bone plate group［（13.6±0.9）cm,（80.2±8.1）minutes,（151.0±15.2）ml,（11.0±1.5）weeks］（ P<0.05）. In both groups, the VAS decreased significantly over time, and markedly increased Constant-Murley score was detected as well（ P<0.05）. The VAS in intramedullary nail group［（2.8±0.2）points,（1.1±0.2）points］was significantly lower than that in bone plate group［（4.0±0.2）points,（1.5±0.1）points］at 1 week and 1 month after operation（ P<0.05）. The Constant-Murley score in intramedullary nail group［（59.9±6.9）points,（79.1±6.8）points］was higher than that in bone plate group［（50.1±8.5）points,（73.6±8.4）points］at 1 month and 3 months after operation（ P<0.05）, but the score showed no significant difference between intramedullary nail group［（89.1±5.3）points］and bone plate group［（86.4±6.4）points］at 1 year after operation（ P>0.05）. According to Constant-Murley score, 10 patients were evaluated as excellent and 15 patients as good in intramedullary nail group at 1 year after operation, with the excellent and good rate of 100%, while 8 patients were evaluated as excellent, 11 patients as good and 2 patients as fair in bone plate group at 1 year after operation, with the excellent and good rate of 91%（ P>0.05）. The cervical trunk angle in intramedullary nail group［（140.2±2.9）°,（139.6±2.3）°］had significant difference from that in bone plate group［（139.6±3.2）°,（138.8±3.3）°］at 2 days and 1 year after operation（ P<0.05）. In both groups, the cervical trunk angle had slight lost at 1 year after operation compared with that at 2 days after operation, but the difference was not statistically significant（ P>0.05）. In intramedullary nail group, 1 patient had subacromial impact. In bone plate group, 1 patient had screw cutting, 2 patients subacromial impact, and 2 patients delayed fracture healing. The incidence of complications in intramedullary nail group was 4%（1/25）, lower than 24%（5/21）in bone plate group（ P<0.05）. Conclusion:Compared with locking nail plate, interlocking intramedullary nail in the treatment of senile varus proximal humeral fracture has the advantages of small trauma, early fracture healing, less pain, early function recovery and less complications.