Objective To explore the impact of suture configuration and fixation type on the biome-chanical strength of rotator cuff repair,using a factorial design study.Methods Sixteen fresh-frozen porcine shoulder samples were randomized into an anchorless double-row suture bridge transosseous su-tures(DS)group,an anchored double-row suture bridge transosseous-equivalent(DE)group,an an-chorless X-BOX construct transosseous sutures(XS)group,and an anchored X-BOX construct transos-seous-equivalent(XE)group,each of four,according to suture configuration(double-row suture bridge,traditional X-BOX construct)and fixation type(suture anchors,transosseous sutures).Then,their fatigue resistance(first-cycle excursion,gap length difference ratio,and the percentage of ex-posed footprints)and the failure strength(the maximum failure load and the re-tear type)were mea-sured using a biomechanical material testing machine.Results Different suture configurations affected failure strength(F=39.559,P<0.001),with the double-row suture bridge groups(693.07±58.35 N,746.76±138.57 N)showing significantly higher failure strength,compared to the traditional X-BOX groups(462.90±18.91 N,421.43±90.76 N).However,the fixation type did not significantly im-pact failure strength(F=1.161,P=0.302).Moreover,the suture configuration influenced the gap differ-ence ratio(F=7.781,P=0.016),but had no significant correlation with other fatigue resistance indica-tors(P>0.05).Meanwhile,failure strength and fatigue resistance were not correlated with fixation type,and the interaction between suture and fixation type(P>0.05).The incidence of failure types for the four suture configurations was as follows:Type I tendon tear:XS>XE>DS=DE;type II tendon tear:DS>XE>XS=DE;fixing material-related failure:DE>DS=XE=XS.Conclusion The failure strength and gap formation ratio in rotator cuff repair under fatigue loading are influenced by suture configuration,whereas no significant association has been observed with respect to fixation method,whether using transosseous sutures or suture anchors.

Objective To explore the impact of suture configuration and fixation type on the biome-chanical strength of rotator cuff repair,using a factorial design study.Methods Sixteen fresh-frozen porcine shoulder samples were randomized into an anchorless double-row suture bridge transosseous su-tures(DS)group,an anchored double-row suture bridge transosseous-equivalent(DE)group,an an-chorless X-BOX construct transosseous sutures(XS)group,and an anchored X-BOX construct transos-seous-equivalent(XE)group,each of four,according to suture configuration(double-row suture bridge,traditional X-BOX construct)and fixation type(suture anchors,transosseous sutures).Then,their fatigue resistance(first-cycle excursion,gap length difference ratio,and the percentage of ex-posed footprints)and the failure strength(the maximum failure load and the re-tear type)were mea-sured using a biomechanical material testing machine.Results Different suture configurations affected failure strength(F=39.559,P<0.001),with the double-row suture bridge groups(693.07±58.35 N,746.76±138.57 N)showing significantly higher failure strength,compared to the traditional X-BOX groups(462.90±18.91 N,421.43±90.76 N).However,the fixation type did not significantly im-pact failure strength(F=1.161,P=0.302).Moreover,the suture configuration influenced the gap differ-ence ratio(F=7.781,P=0.016),but had no significant correlation with other fatigue resistance indica-tors(P>0.05).Meanwhile,failure strength and fatigue resistance were not correlated with fixation type,and the interaction between suture and fixation type(P>0.05).The incidence of failure types for the four suture configurations was as follows:Type I tendon tear:XS>XE>DS=DE;type II tendon tear:DS>XE>XS=DE;fixing material-related failure:DE>DS=XE=XS.Conclusion The failure strength and gap formation ratio in rotator cuff repair under fatigue loading are influenced by suture configuration,whereas no significant association has been observed with respect to fixation method,whether using transosseous sutures or suture anchors.

Objective To observe the clinical efficacy of Zhuanyaotang Granules for the treatment of degenerative lumbar spinal stenosis(DLSS).Methods Using a randomized double blind controlled design,104 DLSS patients were divided into an experimental group and a control group using a random number table method,with 52 patients in each group.The treatment group took oral Zhuanyaotang Granules,methylcobalamin tablets and celecoxib capsule simulants.The control group used Zhuanyaotang Granules simulants,methylcobalamin tablets and celecoxib capsules.The course of treatment was 3 weeks for both groups.The follow-ups were conducted at 1 month and 3 months after treatment.The intermittent claudication distance,visual analogue scale(VAS)score and JOA efficacy rating criteria for low back pain score were observed in both groups before treatment,1,2,3 weeks of treatment and 1 month after treatment and 3 months after treatment.Adverse reactions during treatment were recorded.Results There were 5 cases of detachment and 2 cases of exclusion in the experimental group,and 5 cases of detachment and 1 case of exclusion in the control group.Compared with before treatment,there were statistically significant differences in intermittent claudication distance,VAS score,and JOA score between the two groups of patients at various time points during treatment and follow-up(P<0.05);there was no statistically significant difference in intermittent claudication distance,VAS score,and JOA score between the experimental group and the control group before treatment and 1 and 2 weeks of treatment(P>0.05);compared with the two groups at 3 weeks of treatment and 1 and 3 months after treatment,the intermittent claudication distance and JOA score in the experimental group were lower than those in the control group(P<0.05);There was no significant difference in VAS score between the two groups and the control group after 3 weeks of treatment(P>0.05).There were 2 adverse reactions(4.4%)in the experimental group and 5 adverse reactions(10.8%)in the control group,without statistical significance(P>0.05).Conclusion Zhuanyaotang Granules can effectively relieve pain and improve lumbar function in patients with DLSS,which is more effective and safer than oral celecoxib capsules and methylcobalamin tablets.

Objective:To compare the diagnostic efficacy of 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT, 18F-FDG PET/CT and multi-parameter MRI (mpMRI) in prostate cancer (PCa). Methods:Retrospective analysis was conducted on data from 22 patients ((72.6±6.2) years) with pathologically confirmed PCa in the Affiliated Taizhou People′s Hospital of Nanjing Medical University between April 2021 and September 2022. All patients underwent 18F-PSMA-1007 PET/CT, 18F-FDG PET/CT, and mpMRI examination within 30 d, and the imaging parameters were collected, including PSMA-SUV max, FDG-SUV max, minimum apparent diffusion coefficient (ADC min), mean apparent diffusion coefficient (ADC mean), PSMA-SUV max/ADC min, PSMA-SUV max/ADC mean, FDG-SUV max/ADC min, FDG-SUV max/ADC mean. Patients were divided into groups based on the International Society of Urological Pathology (ISUP) grading (≤3 vs >3) and serum total prostate specific antigen (TPSA; ≤20 μg/L vs >20 μg/L), and differences of imaging parameters between groups were compared (Mann-Whitney U test or independent-sample t test). ROC curves were generated to evaluate the diagnostic ability of each parameter for different levels of PCa. χ2 test and ROC curve analysis were used to compare the detection rate and diagnostic efficiency of three imaging methods for primary focus, lymph node metastasis, and bone metastasis in PCa. Results:Differences were found between ISUP≤3 ( n=6) and >3 ( n=16) groups in PSMA-SUV max/ADC min, PSMA-SUV max/ADC mean, PSMA-SUV max, and ADC min ( z values: from -2.65 to -2.36, t=3.60, P values: 0.002-0.018). But there was no significant difference found between TPSA≤20 μg/L ( n=5) and >20 μg/L ( n=17) groups in all indices ( z values: from -1.76 to -1.45, t values: -1.19 and 1.28, all P>0.05). The optimal cut-off value for PSMA-SUV max/ADC min in differentiating high-grade and low-grade PCa was determined to be 22.628×10 3. In the patient-based analysis, no statistical difference was found in the detection rate of PCa primary tumors among 18F-PSMA-1007 PET/CT, 18F-FDG PET/CT, and mpMRI ( χ2=1.91, P=0.767). However, the detection rates of lymph node and bone metastasis among three imaging methods were significantly different (72.73%(16/22), 59.09%(13/22), 36.36%(8/22) and 81.82%(18/22), 63.64%(14/22), 45.45%(10/22); χ2 values: 6.03, 6.29; P values: 0.049, 0.043). 18F-PSMA-1007 PET/CT resulted in a 36.36%(8/22) increase in N stage and the 40.91%(9/22) increase in M stage compared to mpMRI. Conclusions:PSMA-SUV max/ADC min is a valuable parameter for differentiating high-grade and low-grade PCa. 18F-PSMA-1007 PET/CT demonstrates superior detection rate of PCa lymph node and bone metastasis compared to 18F-FDG PET/CT and mpMRI, and exhibits higher diagnostic efficiency, so it can be recommended for NM staging in patients with PCa.

Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease,with a global prevalence of approximately 30.05% to 32.4% .It is closely associated with various other diseases.In recent years,microRNAs(miRNAs)have played a crucial role as non-invasive biomarkers in understanding the pathogenesis and diagnosis of NAFLD.miRNAs play significant roles in both lipid metabolism and insulin resistance,exerting specific regulatory functions in the development and progression of NAFLD.miRNAs are small RNA molecules that regulate the gene expression and protein synthesis by controlling the transcription and translation of target genes.This article provides a comprehensive overview of the roles and mechanisms of miRNAs in lipid metabolism,insulin resistance,and the occurrence and development of NAFLD.

Objective:To explore the application effect of an intelligent teaching robot system of lifting manipulation in cervical spine manipulation teaching.Methods:60 doctors were randomly divided into an experimental group ( n = 30) and a control group ( n = 30). The control group was taught by a certified chief physician using a combination of "PowerPoint presentations, video demonstrations, and operation demonstrations" . Each part is 5 min. The experimental group was taught by the intelligent teaching robot system with a spinning technique. The teaching time is 15 min for both groups. At the end of the two teaching sessions, the two groups were trained five times under different BMIs and passed the system assessment. The qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude were compared between the two groups. Results:In normal, there was significant differences between the qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude in two groups (all P<0.05). For overweight people, there were significant differences in pre-traction force, pulling force, maximum force, and rotation amplitude (all P <0.05), while there were no significant differences in pre-traction time, pulling time, or pitching amplitude (all P >0.05). In obesity, there were significant differences in pre-traction force, lifting and pulling force, maximum force, and pitch amplitude (all P <0.05), but no significant differences in pre-traction time, lifting and pulling time, or rotation amplitude (all P >0.05). Conclusions:The proposed system can improve the pass rate of spinning manipulation, especially by effectively controlling the pre-traction force, pulling force, and maximum force.

OBJECTIVE: To identify potential mutations of F11 gene in a pedigree affected with hereditary coagulation factor XI (FXI) deficiency and explore its molecular pathogenesis. METHODS: Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), coagulation factor VIII activity (FVIIIC), coagulation factor IX activity (FIXC), coagulation factor XI activity (FXIC), coagulation factor XII activity (FXIIC) and lupus anticoagulation (LA) of the proband and eight family members were determined. FXI antigen (FXIAg) was determined by enzyme-linked immunosorbent assay (ELISA). For the proband, potential mutations in the exons, flanking introns and 5'-, 3'-untranslated regions of the F11 gene were screened by direct DNA sequencing. The results were confirmed by reverse sequencing. Suspected mutations were detected in other family members. ClustalX-2.1-win and four online bioinformatic tools (PolyPhen-2, PROVEAN, SIFT, and Mutation Taster) were used to study the conservation and possible impact of the mutations. The structure of the mutational sites was processed with Swiss-PdbViewer. RESULTS: The propositus had prolonged APTT (69.6 s), whose FXIC and FXIAg were reduced to 6.0% and 10.7%, respectively. Her mother, elder sister, one younger sister, little brother, daughter and son showed slightly prolonged APTT and moderate FXIC and FXIAg levels. Gene sequencing revealed that the propositus carried a heterozygous nonsense mutation c.738G>A (p.Trp228stop) in exon 7 and a heterozygous mutation c.1556G>C (p.Trp501Ser) in exon 13. Her mother, elder sister and daughter were heterozygous for the p.Trp228stop mutation, while one younger sister and little brother and son were heterozygous for p.Trp501Ser. Her husband and the youngest sister were of the wild type. Phylogenetic analysis suggested that Trp501 was highly conserved among all homologous species. The p.Trp501Ser was predicted to be "probably damaging","deleterious", "affect protein function" and "disease causing" corresponding to PolyPhen-2, PROVEAN, SIFT and Mutation Taster. Model analysis demonstrated that the non-polar Trp501 has two benzene rings, forming a hydrogen bond with Gln512 in the wild type. Once substituted by Ser501, the side chain may form another hydrogen bond with the benzene of His396. This may affect the normal space conformation and stability of FXI protein. CONCLUSION The compound heterozygous mutations of the F11 gene probably accounted for the low FXI concentration in this pedigree.
Factor XI ; genetics ; Factor XI Deficiency ; genetics ; Female ; Heterozygote ; Humans ; Male ; Mutation ; Pedigree ; Phylogeny

Objective To investigate the feasibility of manual reduction with inverse shift for pronation-extorsion trimalleolar fracture by applying the finite element method combined with clinical experience. Methods Based on CT images and anatomical features of bone, ligaments and other tissues as well as material parameters, a normal ankle model with completed muscles and bones for a Chinese young male was established. According to the related characteristics of the pronation-extorsion trimalleolar fractures, fracture was simulated in the proper position to make osteotomy model. The finite element model of pronation-extorsion trimalleolar fractures was thus established and then applied with mechanical loading to simulate manual reduction with inverse shift. Results The established finite element model of pronation-extorsion trimalleolar fractures was effectively restored by the displacement loading. Conclusions The finite element analysis on pronation-extorsion trimalleolar fractures by inverse shift maneuver could further prove the feasibility, effectiveness and scientificity of manual reduction with inverse shift based on clinical experience.

OBJECTIVE:To optimize the extraction technology of Yigu granule. METHODS:L9(34)orthogonal test was used, using comprehensive scores of transfer rate of icariin,gentiopicroside,loganic acid and yield rate as evaluation indexes,alcohol volume fraction,the amount of solvent,extraction times and extraction time as investigation factors,extraction technology of Yigu granule was optimized,and the verification test was conducted. RESULTS:The optimized extraction technology was 10-fold 60%ethanol reflux extraction for twice,1 h once. Results of verification test showed,average transfer rates of icariin,gentiopicroside and loganic acid were 81.28%(RSD=1.54%,n=3),48.71%(RSD=2.37%,n=3)and 59.82%(RSD=2.52%,n=3);aver-age yield rate was 31.48%(RSD=1.97%,n=3). CONCLUSIONS:The optimized extraction technology for Yigu granule is sta-ble and feasible with good reproducibility,which can provide basis for the follow-up study of production process.

OBJECTIVETo perform a comparative analysis of the reactivation rate of hepatitis B virus (HBV) infection and related risk factors after treatment of HBV-related hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection.

METHODSWe retrospectively analyzed the HBV reactivation rate and related risk factors of a cohort of 218 patients treated for HBV-related HCC between August 2008 and August 2011; the study population consisted of 125 patients who received RFA and 93 patients who received hepatic resection. Comparisons were made using the unpaired Student's t-test for continuous variables and the x2-test and Fisher's exact test for categorical variables. Univariate and multivariate logistic regression analysis was used to assess risk factors.

RESULTSTwenty patients showed HBV reactivation following treatment, but the incidence was significantly lower in the RFA group than in the hepatic resection group (5.6% vs. 14.0%, 7/125 vs. 13/93, x2 = 4.492, P = 0.034). The univariate and multivariate analysis indicated that no antiviral therapy (OR = 11.7; 95% CI: 1.52-90.8, P = 0.018) and the treatment type (i.e. RFA or hepatic resection) (OR = 3.36; 95% CI: 1.26-8.97, P = 0.016) were significant risk factors of HBV reactivation. Subgroup analysis showed that the incidence of HBV reactivation was lower in patients who received antiviral therapy than in those who did not for both the RFA group and the hepatic resection group but the difference was not significant in the former group (1/68 vs. 19/150, x2=7.039, P = 0.008 and 0/33 vs. 7/92, x2 = 2.660, P = 0.188, respectively). However, the incidence of HBV reactivation in patients who did not receive antiviral therapy was higher than in those who did receive antiviral therapy in the hepatic resection group (12/58 vs. 1/35, x2 = 5.773, P = 0.027).

CONCLUSIONThe incidence of HBV reactivation was lower in patients who received RFA than in those who received hepatic resection to treat HBV-related HCC. Antiviral therapy prior to the hepatic resection treatment may be beneficial for reducing the incidence of HBV reactivation.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; surgery ; virology ; Catheter Ablation ; adverse effects ; Female ; Hepatectomy ; adverse effects ; Hepatitis B virus ; physiology ; Humans ; Incidence ; Liver Neoplasms ; surgery ; virology ; Male ; Middle Aged ; Retrospective Studies ; Virus Activation ; Young Adult