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 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 investigate the effect of the sling massage exercise on postpartum pelvic girdle pain(PPGP). Methods From March,2022 to May,2023,56 patients with PPGP in Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group(n=28)and observation group(n=28).Both groups received routine physical therapy and healthy education,while the control group received exer-cise therapy and the observation group received sling massage exercise,for six weeks.They were assessed with Visual Analog Scale(VAS),Pelvic Girdle Questionnaire(PGQ)and active straight leg raise(ASLR)test before and after treatment,and measured resting and contraction thickness of transversus abdominis with ultrasound;and integrated electromyography(iEMG),root mean square(RMS),median frequency(MF)and mean power fre-quency(MPF)of pelvic floor muscles with surface electromyography. Results After treatment,the total effective rate was 96.43%in the observation group and 78.57%in the control group(Z=2.728,P<0.05).All the indexes improved in both groups(|t|>2.080,P<0.05)except resting thickness of transverse abdominis muscle,and improved more in the observation group than in the control group(|t|>2.161,P<0.05). Conclusion The sling massage exercise can alleviate pain,enhance the stability of the core muscle group,and improve load transfer and quality of life,better than exercise therapy.

This study explores the effects of enhancing the definitive hematopoiesis(DH)signals during the differentiation of human embryonic stem cells(hESCs)into hematopoietic stem/progenitor cells on the generation efficiency and effector function of natural killer(NK)cells generated from hESCs(also known as hESC-NK cells).The hESC(H1)were transformed into embryoid bodies(Ebs)by centrifugation,and during the induction of K562,were used to analyze the efficiency of hematopoietic differentiation,the efficiency of NK cell generation from hESC,the in vitro effector functions,and the expression of effector function related surface receptors.Compared to the control group,the DH group had a significant increase in the number of arterial hematopoietic endothelial cells(CD34+DLL4+)and a significant decrease in primitive hematopoietic related cells(CD34-CD43+)on day 8 of hematopoietic differentiation(P<0.05).On day 28 of NK cell differentiation,the DH group demonstrated a significant increase in the number of NK cells(CD45+CD56+),while a slight increase in the expression of effector function-related molecules such as IFN-γ,Granzyme B,Perforin and CD107a without statistical significance.Furthermore,the activation receptors CD16a and CD69 were significantly increased,NKP46 was significantly decreased,the inhibitory receptor NKG2A was significantly increased,while CD96 was significantly decreased on hESC-NK cells of DH groups(P<0.05).Conclusively,enhancing the signals for definitive hematopoiesis during hESC differentiation into hematopoietic stem/progenitor cells significantly improves the yield of NK cells and the expression of CD16a without affecting their in vitro effector functions.Our study provides a new approach to improving the efficiency of hESC-NK cell or iPSC-NK cell generation.

Objective : To analyze the expression and clinical significance of circ⁃RACGAP1 in bladder cancer tissues , and to explore the influence and mechanism of circ⁃RACGAP1 on the malignant biological behavior of bladder cancer cells. Methods : The expression of circ⁃RACGAP1 in bladder cancer tissues was explored through the TCGA database , and the relationship between the expression of circ⁃RACGAP1 and the clinicopathological features of bladder cancer patients was analyzed. The expression of circ⁃RACGAP1 in cell lines 5637 , T24 , J82 , RT⁃4 and UM⁃UC⁃3 was analyzed by quantitative real⁃time PCR (qPCR) . The circ⁃RACGAP1 knockdown plasmid was transfected into T24 cells by lipofection technology. Colony formation assay , scratch assay and Transwell assay were used to analyze the effects of knocking down circ⁃RACGAP1 on the proliferation , migration and invasion of T24 cells , respectively. The targeted binding between circ⁃RACGAP1 and miR⁃4324 was verified using deepBase , Circbank , CircInteractome , circRNABase databases and a fluorescent reporter system. The effect of knocking down circ⁃RACGAP1 on the expression of miR⁃4324 in T24 cells was detected by qPCR. Western blot was used to detect the effect of knocking down circ⁃RACGAP1 on the expression of recombinant rac⁃GTPase activating protein 1 (RACGAP1) protein and phosphatidylinositol⁃3 ⁃kinase/protein kinase B (PI3K/AKT) signaling pathway proteins in T24 cells. Results circ⁃RACGAP1 was highly expressed in bladder cancer tissues (P < 0. 01) , and its expression increased with the clinical stage of the patients ( P < 0. 01) . The expression of circ⁃RACGAP1 in bladder cancer cell lines was significantly higher than that in normal human bladder epithelial cells ( all P < 0. 01) . Compared with the control group , the proliferation , migration and invasion abilities of T24 cells in the sh⁃circ⁃RAC⁃GAP1 group significantly decreased (all P < 0. 01) . circ⁃RACGAP1 could target and inhibit the expression of miR⁃4324 (P < 0. 01) . Compared with the control group , the expression level of RACGAP1 protein in T24 cells in the sh⁃circ⁃RACGAP1 group decreased (P < 0. 01) , and the expression levels of PI3K/AKT signaling pathway proteins phosphatidylinositol⁃3 ⁃kinase (p⁃PI3K) , phosphorylated protein kinase B (p⁃AKT) , nuclear factor kappa B (NF-κB) decreased (all P < 0. 01) . Conclusion circ⁃RACGAP1 is highly expressed in bladder cancer tissues and cell GAP1 plays a role by inhibiting the expression of miR⁃4324 and activating the PI3K/AKT signaling pathway.

It has been discovered that intestinal fungi play important roles in microecological systems of human body, which affect the human health by influencing gut microbiota directly or indirectly. This article reviews the research progress about the fungi-bacteria interaction, and effects of intestinal fungi and their products on host’s health. The article also discusses the correlation of intestinal fungi with inflammatory bowel disease, colorectal cancer, HBV-related liver diseases, metabolism-associated fatty liver disease and alcoholic liver disease, indicating that intestinal fungi are widely involved in the development of human diseases.

Objective:To explore the application effect of 3D printing technology in comprehensive reconstruction of thumb and finger.Methods:From January, 2018 to January, 2020, 67 patients with 84 thumbs and fingers defects were selected, which were 37 thumbs and 47 fingers, and 45 of I-III degree and 39 of IV-VI degree. The method of operation was comprehensive reconstruction of thumbs and fingers assisted by 3D printing technology. The patient's hands and feet were scanned with CT and 3D modeling, and the 1∶1 model was derived. The skin model and bone model of thumb and finger defect were printed. Put the skin model on the great toes, and design the shape of the nail flap to be cut. Then the flap was spread in the groin area to design the perforating branch flap of the superficial circumflex iliac artery. The interphalangeal joint or metatarsophalangeal joint of the second toe was cut off according to the skeleton model (when the length of the bone joint was not enough, the iliac bone strip was taken to be connected in series). The effect of operation was observed in outpatient.Results:All of the 84 thumbs and fingers survived and were followed-up for 3 to 24 months. The appearance of the reconstructed thumbs and fingers was similar to that of the normal ones, with good texture and elasticity. The nail was smooth and glossy. The sensory recovery was S 3+, and the TPD was 4-6 mm. According to the Evaluation Standard of Finger Replantation and Reconstruction of Hand Surgery Society of Chinese Medical Association, 70 thumbs and fingers were excellent and 14 thumbs and fingers were good. In 64 thumbs and fingers, all toes were preserved in the donor area, and the color and texture of the flap were satisfactory, which did not affect walking, running and jumping, and had no walking pain. Conclusion:With the help of 3D printing technology, the tissues can be cut more accurately during the thumb and finger comprehensive reconstruction, which not only improves the beauty of reconstructed thumbs and fingers, but also avoids unnecessary trauma and improves the satisfaction of patients.

Pulmonary arterial hypertension(PAH) is the most common complication of congenital heart disease(CHD). Because of the complexity and diversity of cardiac anatomy and pathophysiology, as well as a variety of adaptive mechanisms that are not fully understood, little attention is paid on pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH). This article aims to summarize the clinical status, disease characteristics, outcomes, and prognosis of CHD-PAH in Pediatric Cardiology, Beijing Anzhen Hospital, proposing current unresolved issues and future challenges.

Objective To investigate the extents of corpus callosotomy (CC) resulting in optimal seizure control and compare the efficacies and complications of two CC approaches. Methods Clinical data of 25 patients underwent CC in our hospital from January 2013 to December 2018 were retrospectively analyzed. All 25 patients were diagnosed as having medically refractory epilepsy, and 27 CC procedures were performed. The patients underwent either anterior two thirds CC (n=13) or single-stage complete CC (n=12). Two patients had a second-stage posterior CC in 61 and 36 months after anterior CC, respectively. The efficacies were studied by using two evaluation indexes, the effective rate (worthwhile improvements) and the markedly effective rate (favorable outcomes).Results The average postoperative follow-up time was 2.6 years. In comparison, the markedly effective rate (>75％ reduction in seizure frequency or severity) was 71.4％ after complete CC and 15.4％ after anterior two thirds CC with a statistical significant difference between the two groups (P<0.05). The effective rate (>50％ reduction in seizure frequency or severity) of complete CC (78.6％) was higher than that of anterior two thirds CC (53.8％), but without significant difference (P>0.05). Overall, 66.7％ of patients benefited from anterior or complete CC. There were no such complications as intracranial hemorrhage, hydrocephalus, cerebrospinal fluid leakage or postoperative infection.Conclusion Complete CC is more effective for seizure control than anterior two thirds CC; no permanent neurological deficits are observed postoperatively.

Cryptococcal meningitis is a common and refractory central nervous system infection,with high rates of mortality and disability.The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion.Based on the current situation of cryptococcal meningitis in China,the management of cryptococcal meningitis includes 6 aspects:introduction,microorganism identification,clinical manifestations and diagnosis,principles of antifungal therapy,treatment of refractory and recurrent meningitis,treatment of intracranial hypertension.There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis.This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines.The importance of early diagnosis,combined long-term antifungal therapy,control of intracranial hypertension are emphasized.