OBJECTIVE: To explore the advantages and effectiveness of the independently developed intelligent orthopedic robot-assisted distal locking of femoral intramedullary nails. METHODS: Thirty-two adult cadaveric femur specimens were randomly divided into two groups, with 16 specimens in each group. The experimental group used the intelligent orthopedic robot to assist in the distal locking of femoral intramedullary nail holes, while the control group used the traditional method of manual locking under X-ray fluoroscopy. The locking time, fluoroscopy times, and the success rate of first locking were recorded and compared between the two groups. RESULTS: The locking time of the experimental group was (273.94±38.67) seconds, which was shorter than that of the control group [(378.38±152.72) seconds], and number of fluoroscopies was (4.56±0.81) times, which was less than that of the control group [(8.00±3.98) times]. The differences were significant [ MD=73.054 (-37.187, 85.813), P=0.049; MD=1.969 (-1.437, 2.563), P=0.002]. The first locking success rate of the experimental group was 100% (16/16), which was significantly higher than that of the control group (68.75%, 11/16) ( P=0.043). CONCLUSION The efficiency of distal locking of femoral intramedullary nails assisted by the intelligent orthopedic robot is significantly higher than that of the traditional manual locking method under fluoroscopy, as it can markedly reduce the time required for distal locking of femoral intramedullary nails, decrease intraoperative radiation exposure, and increase the success rate of locking.
Humans ; Fracture Fixation, Intramedullary/instrumentation* ; Bone Nails ; Fluoroscopy ; Femur/diagnostic imaging* ; Femoral Fractures/surgery* ; Robotic Surgical Procedures/instrumentation* ; Cadaver ; Adult ; Robotics ; Male

OBJECTIVE: To investigate the value of difference between hematocrit (HCT) and albumin (Alb) in predicting the prognosis of patients with sepsis. METHODS: A retrospective study was conducted on the septic patients hospitalized at the First Affiliated Hospital of Guangxi Medical University from January to October in 2024. Clinical data including gender, age, body mass index (BMI), history of hypertension or diabetes, vital signs on admission, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, blood lactic acid (Lac), oxygenation index (PaO₂/FiO₂), hemoglobin (Hb), white blood cell count (WBC), platelet count (PLT), lymphocyte count (LYM), HCT, Alb, difference between HCT and Alb, bilirubin, scrum creatinine (SCr), and fibrinogen (Fib) within 48 hours of admission were collected. The 28-day prognosis of patients was also recorded. Binary multivariate Logistic regression analysis was used to identify risk factors for 28-day death in patients with sepsis. The predictive efficacy of the difference between HCT and Alb on 28-day death was evaluated using the receiver operator characteristic curve (ROC curve). RESULTS: Among 180 enrolled septic patients, 140 survived and 40 died on 28 days. Compared with the survival group, the patients in the death group was significantly older (years old: 64±16 vs. 55±15, P < 0.05), and had higher SOFA score, APACHE II score, and SCr [SOFA score: 6 (4, 9) vs. 3 (2, 5), APACHE II score: 13 (10, 18) vs. 8 (6, 11), SCr (μmol/L): 136 (70, 416) vs. 77 (58, 126), all P < 0.05] as well as lower Hb, PLT, HCT, difference between HCT and Alb, and Fib within 48 hours of admission [Hb (g/L): 90±30 vs. 106±79, PLT (×10⁹/L): 158 (57, 240) vs. 215 (110, 315), HCT: 0.258±0.081 vs. 0.333±0.077, difference between HCT and Alb: -6.52±7.40 vs. 1.07±7.63, Fib (g/L): 3.72±1.57 vs. 4.59±1.55, all P < 0.05]. No significant difference in gender, BMI, history of hypertension or diabetes, vital signs on admission, or other laboratory indicators was found between the two groups. Binary multivariate Logistic regression analysis revealed that age [odds ratio (OR) = 1.040, 95% confidence interval (95%CI) was 1.004-1.078, P = 0.030], APACHE II score (OR = 1.218, 95%CI was 1.038-1.430, P = 0.016), Hb (OR = 1.040, 95%CI was 1.014-1.068, P = 0.003), and difference between HCT and Alb (OR = 0.804, 95%CI was 0.727-0.889, P < 0.001) were independent risk factors for 28-day death of septic patients. ROC curve analysis showed that the area under the ROC curve (AUC) of difference between HCT and Alb for predicting 28-day death of septic patients was 0.764 (95%CI was 0.679-0.849, P < 0.001). A cut-off value of difference between HCT and Alb ≤ -5.35 yielded a sensitivity of 80.7% and specificity of 65.0%. CONCLUSIONS The difference between HCT and Alb at early admission is a valuable predictor of prognosis in septic patients. A difference ≤ -5.35 indicates an increased death risk of septic patients.
Humans ; Prognosis ; Sepsis/blood* ; Retrospective Studies ; Hematocrit ; Serum Albumin/analysis* ; Male ; Female ; Middle Aged ; Aged ; APACHE

Purpose To investigate the value of MYB and Notch1 immunohistochemical staining in the differential diagno-sis of classic adenoid cystic carcinoma of the breast(C-AdCC)and solid-basaloid adenoid cystic carcinoma of the breast(SB-AdCC).Methods MYB and Notch1 immunohistochemical staining were performed in 20 cases of C-AdCC,6 cases of SB-AdCC and 65 cases of other breast lesions in the archives of pa-thology department.26 cases of AdCC were detected by FISH,and 6 cases of SB-AdCC were detected by NGS.Results MYB immunohistochemical staining showed that C-AdCC(20/20)was moderately or strongly positive,while SB-AdCC(4/6)was mod-erately or strongly positive.Collagenous spherulosis(5/5)showed focal or diffuse weak positivity;Malignant adenomyoepi-thelioma(3/3)was focally moderately or strongly positive;8 matrix-producing carcinomas and 9 secretory carcinomas and 40 non-specific triple-negative breast cancers were negative.Immu-nohistochemistry of Notch1 showed diffuse moderate positive for SB-AdCC(3/6)and negative for C-AdCC(20/20).3 cases of malignant adenomyoepithelioma,5 cases of collagenous spherulo-sis,8 cases of matrix-producing carcinoma,9 cases of secretory carcinoma and 40 cases of non-specific triple-negative breast cancer were negative.FISH showed MYB gene disruption in C-AdCC(12/19)and NGS showed SB-AdCC(3/6)Notch1 muta-tion.Conclusion Moderately or strongly diffuse expression of MYB and Notch1 by immunohistochemistry can assist in the dif-ferentiation of C-AdCC from SB-AdCC,and it can be further clarified by molecular detection when it is difficult to distinguish malignant adenomyoepithelioma.

Objective:To investigate the change of collagen fibers in locally recurrent esophageal squamous cell carcinoma after radical chemoradiotherapy and the discrepancy of adverse effects and survival outcomes among groups with different salvage treatments, provide references for the options of salvage therapy.Methods:Medical records of 137 patients with esophageal squamous cell carcinoma who received radical chemoradiotherapy and had local recurrence admitted to Cancer Center of Renmin Hospital of Wuhan University from January 2015 to September 2022 were retrospectively collected. The expression of collagen fibers in paraffin samples of cases with different recurrence time was determined by Masson staining, and the differences of the average optical density were calculated. According to the salvage treatment after local recurrence, all cases were divided into the salvage surgery group, second-course chemoradiotherapy group and immunochemotherapy group. The differences of survival outcomes and incidence rates of esophageal tracheal fistula, hemorrhage, pericardial effusion, radiation pneumonitis, radiation esophagitis were analyzed among the three groups. The differences of survival rates were analyzed by Kaplan-Meier method and compared by log-rank test among groups.Results:The expression of collagen fibers in recurrent esophageal squamous cell carcinoma was significantly higher than that in primary esophageal squamous cell carcinoma. Collagen fiber expression was gradually down-regulated with the prolongation of recurrence time. The expression of collagen fibers in recurrent cases after 7 years was similar to that of primary esophageal squamous cell carcinoma. The 1-, 2- and 3-year survival rates of patients in the salvage surgery group, the second-course chemoradiotherapy group and the immunochemotherapy group were 47%, 30%, 20%; 50%, 27%, 15% and 72.5%, 50%, 50%, respectively; Immunochemotherapy was more effective in salvage treatment for recurrent esophageal squamous cell carcinoma, but there was no statistical difference.Conclusions:Collagen fibers are abundant in recurrent esophageal squamous cell carcinoma after radical chemoradiotherapy. With prolongation of recurrent interval, the expression of collagen fibers is down-regulated. The survival outcomes of patients in the immunochemotherapy group, salvage surgery group and second-course chemoradiotherapy group were comparable.

Objective To Identify alternative indicators related to the risk of osteoporosis fractures in postmenopausal women through metabolomics and attempting to determine the predictive value of candidate metabolites.Methods From December 2018 to August 2021,158 postmenopausal women with non-traumatic hip fracture(fracture group)were enrolled in our hospital,and 197 postmenopausal women without fracture(non-fracture group)were enrolled.Quantitative analysis of serum metabolites was performed using AbsoluteIDQTM p180 kit and targeted metabolomics approach.Univariate and Multivariate Logistic regression were used to analyze the influencing factors of osteoporotic fracture in postmenopausal women,and Spearman and Pearson analysis were used to analyze their correlation.Results Compared with the non-fracture group,Only serum arginine[(105.2±22.4)μmol/L vs.(96.3±23.5)μmol/L],leucine[(180.9±50.0)μmol/L vs.(156.7±39.5)μmol/L)and spermine[(1.03± 0.67)μmol/L vs.(0.51±0.12)μmol/L]were significantly increased in the fracture group(P＜0.05).Logistic regression analysis showed that only serum spermidine concentration was significantly associated with hip fracture risk after adjustment for age,BMI,complications,and smoking status(HR=1.35,95％CI=1.03 to 1.65,P=0.020).According the receiver operating characteristic,serum spermidine level predicted hip fracture in postmenopausal women with an area under the curve of 0.882(95％CI:0.847 to 0.916).Spearman analysis showed that T value of hip was negatively correlated with serum spermidine level(r=-0.192,P＜0.001).The levels of serum spermine and putrescine in patients of low spermine level group were increased than those in high spermine level group.Pearson correlation analysis showed that serum spermidine level was negatively correlated with spermidine(r=-0.237,P＜0.001)and putrescine(r=-0.189,P=0.004)in fracture group.Univariate and multivariate Logistic regression analysis showed that serum spermidine ≥0.58 μmol/L was an independent risk factor for an increased risk of fragility hip fracture in postmenopausal women(P＜0.001).Conclusion Elevated baseline serum spermidine level are associated with increased risk of hip fracture in postmenopausal women and may be useful in predicting fragility fracture in postmenopausal women.

We reported a 32 years female patient in whom lung metastasis from breast cancer was presented as solitary pulmonary pure ground-glass opacity (GGO) lesion. The patient received rational preoperative examinations and surgery though the preoperative diagnosis was not accurate. Because of different therapy strategies and purposes, it is crucial to make distinction of atypical metastases from primary cancers. Thus, for patients with a history of malignancy, possible metastasis should be taken into consideration if new GGO was found on the CT. Besides this, the follow-up interval of CT should be shortened appropriately, preoperative examinations and surgical procedures should be made according to the suggestions of multidisciplinary team.

Objective:To screen the factors influencing overall survival (OS) of patients undergoing radical resection for colorectal cancer (CRC) and to construct a prognostic model for OS of patients after CRC.Methods:The clinical data of 350 patients with stage Ⅰ-Ⅳ CRC who underwent radical resection in the People's Hospital of Wuhan University from March 2017 to December 2019 were collected retrospectively. Patients were divided into subgroups 0 ( n=70), 1 ( n=172), and 2 ( n=108) according to different preoperative systemic inflammation score (SIS). The relationship between different SIS, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), systemic immune inflammation index (SII) and prognosis of CRC patients undergoing radical surgical resection were analyzed, and Cox regression models were used to perform univariate and multifactorial analyses of factors affecting patient prognosis, and column line graph models were constructed based on the results of multifactorial analyses. Results:By the deadline of follow-up, 80 of 350 CRC patients died, and the 5-year OS rate was 77.14%. The 5-year survival rates of patients in SIS group 0, group 1 and group 2 were 95.71%, 79.65% and 61.11% respectively, with a statistically significant difference ( χ2=30.19, P<0.001). Statistically significant differences in age ( χ2=19.40, P<0.001), tumor site ( χ2=8.18, P=0.017), T stage ( χ2=10.01, P=0.007), TNM stage ( χ2=14.80, P=0.001), tumor diameter ( χ2=13.91, P=0.001) and carcino-embryonic antigen (CEA) level ( χ2=10.12, P=0.006) among patients in SIS group 0, group 1 and group 2. The 5-year OS rates of patients in the low NLR and high NLR groups were 82.67% and 56.16% respectively, with a statistically significant difference ( χ2=24.96, P<0.001) ; the 5-year OS rates of patients in the low LMR and high LMR groups were 66.85% and 88.17% respectively, with a statistically significant difference ( χ2=22.45, P<0.001) ; the 5-year OS rates of patients in the low SII and high SII groups were 86.14% and 69.02% respectively, with a statistically significant difference ( χ2=14.76, P<0.001). Univariate analysis showed that age ( HR=2.58, 95% CI: 1.54-4.32, P<0.001), T stage ( HR=2.41, 95% CI: 1.24-4.68, P=0.009), N stage ( HR=3.03, 95% CI: 1.85-4.94, P<0.001), TNM stage ( HR=3.61, 95% CI: 2.15-6.04, P<0.001), nerve invasion ( HR=1.97, 95% CI: 1.27-3.08, P=0.002), vascular invasion ( HR=2.31, 95% CI: 1.49-3.59, P<0.001), preoperative SIS 1 score ( HR=5.09, 95% CI: 1.57-16.56, P=0.007), SIS 2 score ( HR=11.05, 95% CI: 3.42-35.65, P<0.001), NLR ( HR=2.97, 95% CI: 1.90-4.64, P<0.001), LMR ( HR=0.31, 95% CI: 0.19-0.52, P<0.001), and SII ( HR=2.50, 95% CI: 1.54-4.06, P<0.001) were all independent influence factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection; multivariate analysis showed that age >60 years ( HR=2.27, 95% CI: 1.31-3.91, P=0.003), TNM stage Ⅲ-Ⅳ ( HR=7.08, 95% CI: 1.89-26.59, P=0.004), and preoperative SIS 2 score ( HR=4.02, 95% CI: 1.09-14.83, P=0.037) were all independent risk factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection. The nomogram model built based on the screened variables has high prediction accuracy: the C-index of the nomogram was 0.75. Conclusion:Age>60 years old, TNM stage Ⅲ-Ⅳ, SIS 2 score are all independent risk factors for postoperative prognosis of colorectal cancer. The nomograph model constructed by this method has high prediction accuracy.

Objective:To compare the biomechanical differences of dynamic condylar screw (DCS), locking compression plate (LCP) combined with DCS and medial anatomic buttress plate (MABP) combined with DCS in the revision of medial defective intertrochanteric fractures by finite element analysis.Methods:The femoral CT imaging data provided by a healthy adult volunteer were used to reconstruct the solid three-dimensional model of femur by Mimics 21.0 and Geomagics Studio 12. Evans-Jensen II B intertrochanteric fracture was established by Ansys Workbench18.0. The three-dimensional models of proximal femoral nail antirotation (PFNA), DCS, LCP and MABP were reconstructed in Solidworks 2015. The PFNA was assembled with the fracture model, and then the PFNA was removed to establish the postoperative failure model of femoral intertrochanteric fracture and then simulated the fixation in the hip-preserving revision surgery of femoral intertrochanteric fractures: non-medial support reconstruction group (DCS); indirect medial support reconstruction group (DCS+LCP) and partial direct medial support reconstruction group (DCS+MABP). Finally, the forces on the hip joint of 70 kg normal people during standing (700 N), slow walking (1,400 N), brisk walking (1,750 N) and going up and down stairs (2,100 N) were simulated in Abaqus 6.14, the relative displacement and stress peak value of fracture end and stress distribution and stress peak value of internal fixation in different models were recorded.Results:At 700 N axial load, the relative displacement of fracture end fixed by DCS, DCS+LCP and DCS+MABP was 0.28, 0.13 and 0.09 mm; the peak stress of the fracture end was 49.01, 15.29 and 1.35 MPa; the peak stress of internal fixation was 230, 220 and 174 MPa, respectively. At 1,400 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.56, 0.24 and 0.16 mm; the peak stress of fracture end was 108.49, 28.96 and 3.12 MPa; the peak stress of internal fixation was 469, 352 and 324 MPa, respectively. At 1,750 N axial load, the relative displacement of the fracture end of the three group was 0.70, 0.30 and 0.20 mm; the peak stress of the fracture end was 139.59, 37.57 and 4.17 MPa; the peak stress of internal fixation was 594, 421 and 393 MPa, respectively. At 2,100 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.85, 0.35 and 0.23 mm; the peak stress of the fracture end was 170.05, 46.36 and 5.24 MPa; the peak stress of internal fixation was 724, 504 and 460 MPa, respectively.Conclusion:The partial direct reconstruction of medial support under the neck by DCS+MABP may have better biomechanical properties in the revision of medial defective intertrochanteric fractures.

Objective: To establish a reliable and sensitive method for evaluating quality of Yiqi Jiangzhi Granules (YQJZG). Methods: Ultra performance liquid chromatography electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS) was employed for simultaneous determination of eight marker components. Separation was performed on an AQUITY UPLC® HSS T3 column, the mobile phase consisted of acetonitrile as the organic phase and 0.1% (volume percentage) formic acid as the aqueous. Eight marker components, ginsenoside Rg1 (GRg1), ginsenoside Re (GRe), ginsenoside Rb1 (Gb1), typhaneoside (TEO), isorhamnetin-3-O-neohespeidoside (IN), hesperidin (HPD), aurantio-obtusin-6-O-β-D-glucoside (AG) and curcumin (CCM), were detected by multiple reaction monitoring (MRM) mode. The Chinese Pharmacopoeia (2020 edition) was regarded as the guidance document for this method validation. Results: The method showed good linearity (R

SIRT6 belongs to the conserved NAD⁺-dependent deacetylase superfamily and mediates multiple biological and pathological processes. Targeting SIRT6 by allosteric modulators represents a novel direction for therapeutics, which can overcome the selectivity problem caused by the structural similarity of orthosteric sites among deacetylases. Here, developing a reversed allosteric strategy AlloReverse, we identified a cryptic allosteric site, Pocket Z, which was only induced by the bi-directional allosteric signal triggered upon orthosteric binding of NAD⁺. Based on Pocket Z, we discovered an SIRT6 allosteric inhibitor named JYQ-42. JYQ-42 selectively targets SIRT6 among other histone deacetylases and effectively inhibits SIRT6 deacetylation, with an IC₅₀ of 2.33 μmol/L. JYQ-42 significantly suppresses SIRT6-mediated cancer cell migration and pro-inflammatory cytokine production. JYQ-42, to our knowledge, is the most potent and selective allosteric SIRT6 inhibitor. This study provides a novel strategy for allosteric drug design and will help in the challenging development of therapeutic agents that can selectively bind SIRT6.