Objective To investigate the changes in the structural parameters and mechanical properties of the necrotic femoral head and compare the effects of core decompression and hone grafting with those of bone cement filling on the mechanical properties and pre-vention of articular surface collapse of the necrotic femoral head.Methods Thirty-two fresh human femoral heads were collected from patients who underwent total hip arthroplasty at our hospital between June 2020 and January 2022.The femoral heads were divided into four groups:8 femoral neck fractures(TFF group),8 osteonecrosis of the femoral head(ONFH group),8 osteonecrosis of the femoral head treated with cement percutaneous injection(CPI group),and 8 osteonecrosis of the femoral head treated with core decompression and bone graft(CDBG group).Cement filling or core decompression was performed under radiographic guidance.All samples were scanned and three-dimensionally reconstructed using micro-CT.The spatial heterogeneity of the femoral head was observed,and the bone morphometric parameters of each region of interest were calculated.Mechanical analysis was performed to evaluate the femoral head parameters of dis-placement and stress in vitro.Results Bone microarchitecture and morphometry in necrotic femoral heads were markedly altered.The biomechanical properties of the necrotic zone in the femoral head were markedly weakened.After the necrotic area was filled with bone cement,the biomechanical properties of the necrotic zone of the femoral head increased significantly.In addition,after core decompres-sion and bone grafting in the necrotic area,the biomechanical properties increased significantly in the necrotic zone of the femoral head.Conclusion Bone cement filling or bone grafting in the necrotic area can change the biomechanical mechanism of the femoral head,improve the load-supporting ability,and prevent femoral head collapse.Cement filling may be a practical approach for the treatment of osteonecrosis of the femoral head that can be useful for practicing orthopedists.

Objective To develop a pulmonary rehabilitation training system based on scenario simulation for children with bronchiolitis obliterans,and to explore its application effect.Methods A pulmonary rehabilitation training program for children with bronchiolitis obliterans was constructed,and on the basis of this program,a pul-monary rehabilitation training system based on scenario simulation was developed for children with bronchiolitis obliterans,with real-time monitoring of relevant data.44 children with bronchiolitis obliterans who were hospitalized in the Department of Respiratory Medicine of a tertiary A children's specialized hospital in Hunan Province from January to December 2022 were selected by convenience sampling method,and the subjects were divided into an experimental group and a control group with 22 cases in each group.The experimental group adopted a pulmonary rehabilitation training program based on scenario simulation,and the control group implemented pulmonary rehabili-tation through nurse demonstration and guidance.At pre-intervention,4 weeks,and 12 weeks of intervention,the 2 groups were compared in terms of clinical symptom severity,pulmonary function,adherence to pulmonary rehabilita-tion,and the occurrence of pulmonary rehabilitation-related adverse events.Results There were no shedding cases in the experimental group and a case in the control group,and 22 cases were finally included in the experimental group and 21 cases in the control group.The results of repeated measures ANOVA showed that the comparison of clinical symptom severity and pulmonary function between the 2 groups at different time points was statistically sig-nificant in terms of time,between groups and interaction(P＜0.05).Simple effect analysis showed that after 4 and 12 weeks of intervention,the severity of clinical symptoms in the experimental group was lighter than that in the control group,and the difference was statistically significant(P＜0.001).At 12 weeks of intervention,pulmonary func-tion indexes,such as exertional expiratory volume in the first second,exertional lung volume,and maximum expiratory flow rate,were higher in the experimental group than those in the control group,and the difference was statistically significant(P＜0.001).At 4 and 12 weeks of intervention,the compliance of pulmonary rehabilitation in the experi-mental group was higher than that of the control group,and the difference was statistically significant(P＜0.05).At 12 weeks of intervention,the occurrence of adverse events related to pulmonary rehabilitation in the experimental group was less than that in the control group,and the difference was statistically significant(P=0.026).Conclusion The use of a scenario simulation-based pulmonary rehabilitation training system for children with bronchiolitis obliterans can effectively alleviate the clinical symptoms of children,improve their pulmonary function,increase compliance,and reduce the occurrence of pulmonary rehabilitation-related adverse events.

Objective:To evaluate the optimization effect of transcutaneous electrical acupoint stimulation (TEAS) combined with moderate sedation with propofol (TEAS-propofol balanced anesthesia) for gastrointestinal endoscopy.Methods:This was a single-blind randomized controlled trial. American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 18-64 yr, undergoing elective gastrointestinal endoscopy at the Endoscopic Diagnosis and Treatment Center of the Affiliated Hospital of Qingdao University from May to August 2022, were divided into 2 groups using the block random allocation method: conventional anesthesia group (group C) and TEAS-propofol balanced anesthesia group (group TPB). Patients received moderate sedation with propofol plus routine anesthesia with fentanyl 50 μg in group C. In TPB group, TEAS was performed at bilateral Neiguan, Hegu and Zusanli acupoints before surgery until the end of surgery, and patients received propofol for moderate sedation (Modified Observer′s Assessment of Alertness/Sedation scale score was 3). The efficacy and safety of anesthesia and parameters related to outcomes were observed and recorded.Results:In this study, 66 patients were recruited, with 33 in each group, the failure rate of anesthesia in both groups was 3%, and no reflux or aspiration was found. Compared with group C, no significant changes were found in the patients′ satisfaction on the same day, intraoperative pain response score, incidence of intraoperative adverse reactions (tachycardia, hypertension, bucking and body movement), awake time, consumption of propofol, rate of intraoperative awareness and rate of patients hoping to receive the same anesthesia method again postoperatively ( P>0.05), the patients′ satisfaction was significantly increased on the next day ( P<0.05), the incidence of intraoperative respiratory depression, physician satisfaction, and degree of postoperative dizziness and nausea were significantly reduced ( P<0.05), and the discharge time and time to the complete recovery of normal behavior function was significantly shortened in group TPB ( P<0.05). Conclusions:The combination of TEAS at bilateral Neiguan, Hegu and Zusanli acupoints with moderate sedation using propofol for gastrointestinal endoscopy is not only safe and effective, but also beneficial to the postoperative outcome of patients, and the effect is better than that of conventional anesthesia with propofol and fentanyl.

Objective:To investigate the clinical characteristics of psoriasis and status quo of medical care for patients in county areas of China.Methods:This study was a cross-sectional investigation. Based on the “Qianxian Wuyin” Project (a national project for upgrating ability for psoriasis care at county level), an online questionnaire survey was conducted in the dermatology departments of 459 county hospitals in 404 pilot administrative counties across China from February to June 2023. The questionnaire included demographic information of patients (gender, ethnicity, age, place of residence, education, marital status), and clinical characteristics of psoriasis (disease course, type, comorbidities, body surface area (BSA) and previous treatment. The Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) were applied for assessing the quality of life and disease severity, and completed by patients or guardian and doctors, respectively.Results:A total of 16 935 patients completed the questionnaire. The age of patients was 1-102(44.17±11.58)years, and 71.0% (12 036/16 935) were 30-59 years old. The ratio of male to female was 2.21∶1; 24.3%(4 117/16 935) of patients had high school education; there were 9 940 patients(58.7%) with previous or current smoking and/or alcohol use; 42.8%(7 218/16 855) of patients had a disease course of 1-5 years. There were 15 630 patients(92.3%) with DLQI≥10, 8 346 patients(49.7%) with PASI≥10, 15 017 patients(89.2%) with BSA≥10%. The plaque type was the most common disease type ( n=14 965, 88.7%), and spotting type ranked the second ( n=1 141, 6.8%). The most common initial site was the trunk ( n=12 309, 72.9%). Among the comorbidities, hypertension was the most common one ( n=1 681, 10.0%). There were 7 650 reports of treatment response to conventional topical drug therapy and 3 112 reports of treatment response to systemic drug therapy, with 6 269 (81.9%) and 2 493 (80.1%) reporting poor or no response, respectively. Conclusions:The survey shows that in the county areas of China, the majority of psoriasis patients are severe patients with short course of disease, plaque type is the most common type, and hypertension is the most common comorbidity; and the conventional treatment is less effective for most patients.

Objective: QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. Methods: This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. Results: Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46).The median duration of response was 9.6 months (95% confidence interval [CI]=5.5–not estimable). The median progression-free survival was 8.1 months (95% CI=5.7–14.0). Fortyfive (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). Conclusion QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can’t tolerate bevacizumab, which needs to be further verified in phase III confirmatory study.

ObjectivesTo observe the clinical effectiveness， safety， and potential mechanism of Yisui Shengxue Pills （益髓生血丸） as adjuvant treatment for myelosuppression after chemotherapy for malignant tumours with qi and yin deficiency syndrome. MethodsEighty patients of myelosuppression after chemotherapy for malignant tumours with qi and yin deficiency syndrome were randomly divided into trial group and control group， with 40 cases in each group. Both groups received conventional western medicine treatment， while the control group added placebo taken orally， and the trial group received Yisui Shengxue Pills orally， and both groups were treated for 21 consecutive days. Granulocyte colony stimulating factor （G-CSF）， granulocyte-macrophage colony stimulating factor （GM-CSF）， soluble intercellular cell adhesion molecule-1 （sICAM-1）， Jagged 1 （Jagl）， Notch homolog 2 （Notch2）， cell fate determinant membrane associated protein 1 （Numb1）， neutrophils， platelet count， white blood cell count， hemoglobin， cluster of differentiation 4⁺ （CD4⁺）， and cluster of differentiation 8⁺ （CD8⁺） were detected before and after treatment； myelosuppression grade and TCM syndrome scores of the two groups were evaluated before and after treatment， and clinical effectiveness and adverse events of the two groups were compared. ResultsThe difference in myelosuppression grading between the two groups after treatment was statistically significant （P＜0.05）. Compared with this group before treatment， plasma G-CSF， GM-CSF， sICAM-1， Numb1 expression， platelet count， neutrophil count， leukocyte count， haemoglobin， CD4⁺ level decreased， Jagl， Notch2 expression and CD8⁺ level increased， and fatigue， spontaneous sweating， palpitation， night sweating， insomnia， scanty complexion， mouth erosion， vexing heat in chest， palms and soles scores all reduced （P＜0.05）. Compared with the control group after treatment， plasma G-CSF， GM-CSF， sICAM-1， Numb1 expression， platelet count， neutrophil count， leukocyte count， haemoglobin， CD4+ levels increased， Jagl， Notch2 expression and CD8⁺ levels decreased， and fatigue， spontaneous sweating， palpitations， night sweating， insomnia， pale face， mouth erosion， and vexing heat in chest， palms and soles scores decreased in trial group （P＜0.05）. The total effective rate of the trial group was 95.00%， which was significantly higher than that of the control group， which was 80.00% （P＜0.05）. Comparison of the incidence of liver function damage and renal function damage between the two groups showed no statistically significant difference （P＞0.05）， and the incidence of gastrointestinal damage in the trial group was lower than that in the control group （P = 0.02）. ConclusionYisui Shengxue Pills as adjuvant treatment for myelosuppression after chemotherapy for malignant tumours with qi and yin deficiency syndrome can improve the myelosuppression and clinical symptoms， improve the clinical effectiveness， and has a good synergistic and toxicity-reducing effect， and its mechanism of action may be related to the regulation of the Notch signalling pathway and the reduction of immune function impairment.

Objective:To explore the influencing factors for compliance to colonoscopy screening for colorectal cancer in outpatients.Methods:Patients aged 40-74 years who visited the outpatient gastroenterology department of 7 tertiary hospitals in 7 regions of Xinjiang from January 2022 to June 2022 were enrolled. Recommendations for colonoscopy screening were made according to the patient's medical conditions, and the questionnaire was used to collect information. The Chi-square test was used to compare the differences of compliant and non-compliant patients. Multivariate logistic regression was used to analyze the influencing factors of compliance to colonoscopy screening.Results:A total of 463 valid questionnaires were obtained from 7 centers, in which, 427 outpatients (92.2%) followed the recommendation for colonoscopy screening, and 36 (7.8%) did not. Chi-square test results showed that there were statistically significant differences between the two groups in gender, age, education, subjective cognition of intestinal polyps, personal history of colorectal polyps, family history of colorectal cancer, family history of colorectal polyps, abdominal pain or distension, and defecation habit or stool changes ( P<0.05). The results of multivariate regression analysis showed that the screening compliance of patients aged 40-49 years ( P=0.005, OR=0.141, 95% CI: 0.036-0.549) and 50-59 years ( P=0.039, OR=0.257, 95% CI: 0.071-0.932) was lower than that of patients aged 60-74 years. The screening compliance of patients with high school education ( P=0.011, OR=3.121, 95% CI: 1.304-7.473) and college education or above ( P=0.016, OR=3.544, 95% CI: 1.270-9.890) was higher than those with primary school education and below. Patients with personal history of colorectal polyps ( P=0.015, OR=12.288, 95% CI: 1.629-92.719), family history of colorectal cancer ( P=0.038, OR=8.506, 95% CI: 1.124-64.351) and changes in defecation habit or stool trait ( P=0.039, OR=4.794, 95% CI: 1.085-21.192) also had higher compliance. Conclusion:Age, educational level, personal history of colorectal polyps, and family history of colorectal cancer are related to colonoscopy screening compliance in outpatients of 7 tertiary hospitals in 7 regions of Xinjiang. The independent risk factors affecting compliance to colorectal cancer screening in outpatients are age of 40-59 years, lower educational level, no previous history of polyps or family history of colorectal cancer, and no defecation habit or stool changes.

Objective:To discuss the protective effect of sodium butyrate(NaB)on acute liver injury in the mice induced by lipopolysaccharide(LPS)combined with D-galactosamine(D-Gal),and to clarify its mechanism.Methods:Thirty male Kunming mice were randomly divided into control group,model group,and NaB group,and there were 10 mice in each group.The mice in NaB group were given 200 mg·kg-1·d-1 NaB,while the mice in control group and model group were given an equal volume of sterile water.The mice in model group and NaB group were intraperitoneally injected with 20 μg·kg-1 LPS and 600 mg·kg-1 D-Gal to induce the acute liver injury models.The body weights and liver weights of the mice in various groups were detcted,and the liver index was calculated.HE staining was used to observe the pathomorphology of liver tissue of the mice in various groups;kits were used to detect the activities of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in serum,and the activities of total superoxide dismutase(T-SOD)and catalase(CAT),and the levels of malondialdehyde(MDA)in liver tissue of the mice in various groups;Western blotting method was used to detect the expression levels of nuclear factor E2-related factor 2(Nrf2)and heme oxygenase-1(HO-1)proteins in liver tissue of the mice in various groups.Results:There were no significant differences in body weights of the mice among various groups(P>0.05).Compared with control group,the liver index of the mice in model group was significantly increased(P<0.01).Compared with model group,the liver index of the mice in NaB group was significantly decreased(P<0.01).The HE staining results showed that the liver tissue of the mice in control group exhibited normal structure,with clear boundaries of hepatocytes,consistent size,radially arranged around the central vein,and the nucleus located in the center of the cells;in model group,the arrangement of hepatocytes was disordered,the cells were swollen,there were multiple foci of hepatocellular necrosis,inflammatory cell infiltration,and hemorrhage;compared with model group,the cells in NaB group showed improved hepatocellular structure and reduced inflammatory infiltration.Compared with control group,the activities of ALT and AST in serum of the mice in model group were significantly increased(P<0.01);compared with model group,the activities of ALT and AST in serum of the mice in NaB group were significantly decreased(P<0.05 or P<0.01).Compared with control group,the activities of T-SOD and CAT in liver tissue of the mice in model group were significantly decreased(P<0.01),and the level of MDA was significantly increased(P<0.01);compared with model group,the activities of T-SOD and CAT in liver tissue of the mice in NaB group were significantly increased(P<0.05 or P<0.01),and the level of MDA was significantly decreased(P<0.01).The Western blotting results showed that compared with control group,the expression levels of Nrf2 and HO-1 proteins in liver tissue of the mice in model group were significantly decreased(P<0.05);compared with model group,the expression levels of Nrf2 and HO-1 proteins in liver tissue of the mice in NaB group were significantly increased(P<0.01).Conclusion:NaB has a protective effect on LPS/D-Gal induced acute liver injury in the mice,and its mechanism may be related to the upregulation of the expressions of Nrf2 and HO-1 proteins and the increas of the activity of oxidant enzyme in liver tissue by NaB,thereby reduces the liver oxidative stress level of liver.

Objective:The causal relationship between eczema and autoimmune diseases has not been previously reported.This study aims to evaluate the causal relationship between eczema and autoimmune diseases. Methods:The two-sample Mendelian randomization(MR)method was used to assess the causal effect of eczema on autoimmune diseases.Summary data from the Genome-Wide Association Study Catalog(GWAS)were obtained from the Integrative Epidemiology Unit(IEU)database.For eczema and autoimmune diseases,genetic instrument variants(GIVs)were identified according to the significant difference(P＜5×10-8).Causal effect estimates were generated using the inverse-variance weighted(IVW)method.MR Egger,maximum likelihood,MR-PRESSO,and MR-RAPS methods were used for alternative analyses.Sensitivity tests,including heterogeneity,horizontal pleiotropy,and leave-one-out analyses,were performed.Finally,reverse causality was assessed. Results:Genetic susceptibility to eczema was associated with an increased risk of Crohn's disease(OR=1.444,95％CI 1.199 to 1.738,P＜0.001)and ulcerative colitis(OR=1.002,95％CI 1.001 to 1.003,P=0.002).However,no causal relationship was found for the other 6 autoimmune diseases,including systemic lupus erythematosus(SLE)(OR=0.932,P=0.401),bullous pemphigoid(BP)(OR=1.191,P=0.642),vitiligo(OR=1.000,P=0.327),multiple sclerosis(MS)(OR=1.000,P=0.965),ankylosing spondylitis(AS)(OR=1.001,P=0.121),rheumatoid arthritis(RA)(OR=1.000,P=0.460).Additionally,no reverse causal relationship was found between autoimmune diseases and eczema. Conclusion:Eczema is associated with an increased risk of Crohn's disease and ulcerative colitis.No causal relationship is found between eczema and SLE,MS,AS,RA,BP,or vitiligo.

Objective: QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. Methods: This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. Results: Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46).The median duration of response was 9.6 months (95% confidence interval [CI]=5.5–not estimable). The median progression-free survival was 8.1 months (95% CI=5.7–14.0). Fortyfive (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). Conclusion QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can’t tolerate bevacizumab, which needs to be further verified in phase III confirmatory study.