OBJECTIVE: To explore the effectiveness of additional anti-rotation steel plate assisted intramedullary nail technology in treatment of aseptic femoral non-union patients. METHODS: A retrospective analysis was conducted on 21 patients with aseptic femoral non-union who admitted between September 2020 and October 2024 and treated with additional anti-rotation steel plate assisted intramedullary nail technology. There were 17 males and 4 females, aged 25-67 years (mean, 44 years). There were 19 cases of femoral anterograde intramedullary nail fixation, 1 case of femoral retrograde intramedullary nail fixation, and 1 case of steel plate fixation with fatigue fracture. There were 9 cases of hypertrophic non-union and 12 cases of atrophic non-union. All patients had varying degrees of fracture end atrophy/sclerosis. Among them, 20 patients who were fixed with intramedullary nails underwent removal of soft tissue and hardened bone at the fracture end, and cortical treatment resulted in the appearance of "chili sign" at the fracture end. Iliac bone grafting and anti-rotation steel plate fixation were performed. One patient with steel plate fixation was removed the steel palte and fixed with a retrograde intramedullary nail, while the hardened bone at the fracture end was removed, iliac bone grafting and anti-rotation steel plate fixation were performed. Postoperative follow-up observation included the incision healing, maximum knee flexion range of motion, bone healing, length of lower limbs, and subjective satisfaction. The lower extremity functional scale (LEFS) score was used to evaluate the lower limb function. RESULTS: All incisions healed by first intention. All patients were followed up 7-26 months (mean, 15.5 months). At last follow-up, the femoral fracture healed with the obvious callus formation at the fracture end; the maximum knee flexion range of motion was 95°-127° (mean, 112.67°). The LEFS score increased from 29.9±6.7 before operation to 75.9±3.0 at last follow-up, and the difference was significant (t=-29.622, P<0.001). Except for 1 patient who underwent intramedullary nail dynamic treatment before operation and had a lower limb shortening of about 0.9 cm, the other patients had bilateral lower limbs of equal length. All patients had no postoperative infections, mal-union of fractures, deep vein thrombosis, joint stiffness, or other complications. CONCLUSION The use of additional anti-rotation steel plate assisted intramedullary nail technology in the treatment of aseptic femoral non-union not only overcomes the drawbacks of insufficient stability at the fracture end of intramedullary nails, but also overcomes the shortcomings of biased fixation with steel plates. It has the advantages of minimal trauma, effective maintenance of fracture stability, and ideal postoperative functional recovery, making it an effective treatment for aseptic femoral non-union.
Humans ; Male ; Fracture Fixation, Intramedullary/instrumentation* ; Female ; Bone Plates ; Middle Aged ; Adult ; Femoral Fractures/surgery* ; Retrospective Studies ; Bone Nails ; Aged ; Fractures, Ununited/surgery* ; Treatment Outcome ; Bone Transplantation/methods* ; Steel ; Fracture Healing

Objective To analyze the prognostic value of serum galectin-3(Gal-3)and reverse triiodothyronine(rT3)levels in predicting prognosis of elderly patients with chronic heart failure(CHF).Methods A total of 130 elderly CHF patients admitted to the Geriatric Hospital Affiliated to Wuhan University of Science and Technology from May 2022 to May 2023 were enrolled as study group,and 65 elderly healthy individuals undergoing physical examination served as control group.Serum Gal-3 and rT3 levels were compared between the two groups.Based on the prognosis after a 12-month follow-up,patients in the study group were divided into poor prognosis group and good prog-nosis group,and the impact of serum Gal-3 and rT3 levels at admission on prognosis of elderly CHFpa-tients and their value in predicting poor prognosis were analyzed.Results The serum Gal-3 and rT3 levels in the study group were higher than those in the control group(P＜0.05).During follow-up period,4 patients in the study group were lost in follow-up,and the poor prognosis rate among the patients who completed the follow-up was 30.95％.At admission,the left ventricular ejection frac-tion(LVEF)was lower in the poor prognosis group than that in the good prognosis group,while the serum levels of Gal-3,rT3,creatine kinase isoenzyme MB(CK-MB),and N-terminal pro-brain na-triuretic peptide(NT-proBNP)were higher in the poor prognosis group(P＜0.05).Elevated ser-um Gal-3 and rT3 levels at admission were independent risk factors for poor prognosis in elderly CHF patients(P＜0.05).The areas under the curve(AUCs)for predicting poor prognosis in elderly CHF patients based on serum Gal-3,rT3,LVEF,CK-MB,and NT-proBNP levels at admission were 0.731,0.728,0.736,0.741,and 0.740,respectively.The AUC for the combined predic-tion using Gal-3 and rT3 was 0.865,which was greater than the AUCs for Gal-3,rT3,LVEF,CK-MB,and NT-proBNP alone(P＜0.05).High levels of serum Gal-3 and rT3 at admission ex-hibited a positive sub-multiplicative interaction in predicting prognosis of elderly CHF patients(P＜0.05).Conclusion Elevated serum Gal-3 and rT3 levels in elderly CHF patients are independent risk factors for poor prognosis,and combined detection can provide a reliable basis for clinically i-dentifying high-risk patients with poor prognosis.

Objective:To investigate the mechanism of ursolic acid regulating HMGB1/TLR4 pathway in reducing intestinal barrier injury in a rat model of ulcerative colitis(UC).Methods:Rats were randomly divided into control group,model group,glycyr-rhizic acid(HMGB1 inhibitor)group,ursolic acid group and glycyrrhizic acid+ursolic acid group,with 12 rats in each group.UC rat model was induced by tritrobenzene sulfonate enema.After drug administration,body weight and disease activity index(DAI)score were performed of rats in each group;pathological morphology of colonic mucosa was detected by HE staining,the thickness of mucosa and height of villi were compared;levels of catalase(CAT),superoxide dismutase(SOD),malondialdehyde(MDA)in colon tissue,levels of serum diamine oxidase(DAO),and intestinal fatty acid binding protein(I-FABP),TNF-α,IL-18,IL-6 were detected by kits;expression levels of tight junction proteins(Claudin-1,ZO-1,Occludin)and HMGB1/TLR4 pathway proteins(HMGB1,TLR4,MyD88)in colon tissues were detected by Western blotting.Expression levels of HMGB1,TLR4 and MyD88 in colonic tissue were detected by immunohistochemistry.Results:Compared with control group,colonic mucosal tissue of model group had severe pathological injury,the body weight,mucosal thickness,villus height,CAT,SOD,Claudin-1,ZO-1 and Occludin levels in colon tis-sue were significantly reduced,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly increased(P<0.05);compared with model group,pathological injury of colonic mucosal tissue of rats in ursolic acid group,glycyrrhizic acid group and glycyrrhizic acid+ursolic acid group were reduced,body weight,muco-sal thickness,villus height,colon tissue CAT,SOD,Claudin-1,ZO-1 and Occludin levels were significantly increased,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly reduced(P<0.05);combined intervention of glycyrrhizic acid and ursolic acid could enhance the influence of ursolic acid on the above indexes(P<0.05).Conclusion:Ursolic acid can inhibit inflammation,reduce the level of oxidative stress,reduce the colonic mucosal injury of UC rats,repair the intestinal mucosal barrier function,and improve the clinical symptoms of rats,which may be achieved by down-regulating the HMGB1/TLR4 pathway.

The key link to colorectal cancer progression is that epigenetic derangements promote reprogramming of glucose metabolism.Based on many studies on the relationship between spleen being the origin of acquired constitution and epigenetics,spleen qi dispersing essence and glucose metabolism,combined with the extensive experience of traditional Chinese medicine in the treatment of colorectal cancer and the accumulation of researches on glucose metabolism,it is believed that the"epigenetic-reprogramming of glucose metabolism"pathology of colorectal cancer is the microscopic essence of the key pathogenesis of"dysfunction of spleen transforming essences".The"promoting spleen and dispersing essences"method means that"promoting spleen"to reverse epigenetic derangements and"dispersing essences"to regulate reprogramming of glucose metabolism was put forward to treat colorectal cancer.Look forward to enrich the scientific connotation of the pathogenesis of"dysfunction of spleen transforming essences",new ideas and potential empirical basis for traditional Chinese medicine intervention in colorectal cancer were provided.

Objective To investigate the efficacy and safety of self-help inflatable balloon in the treatment of refractory benign upper digestive tract stricture.Methods From November 2022 to February 2024,10 patients with refractory benign upper digestive tract stricture underwent self-help inflatable balloon were retrospectively analyzed.Preoperative treatment,intraoperative and postoperative complications,dysphagia score before and after surgery,wearing time of external self-help inflatable balloon,and the clinical efficacy were evaluated.Results All the 10 patients received self-help inflatable balloon treatment.No complications such as bleeding and perforation occurred in all patients during the wearing of the balloon.The placement time of the balloon was 60～180 d,and the average wearing time was 104.9 d.Before surgery,nine cases had a stricture segment length less than 2 cm,and one case had a stricture segment length of 6 cm.The dysphagia score before surgery was(3.60±0.52),and the dysphagia score after removal of the self-help inflatable balloon was(0.60±0.52),and there was statistical significance in preoperative and postoperative comparison(P＜0.05).The dysphagia score 3 months after removal of the external self-help inflatable balloon was(0.70±0.48),there was no significant difference in dysphagia score between the day after surgery and 3 months after surgery(P＞0.05).The diameter of the stricture before and after operation was(5.09±2.02)mm and(10.35±0.73)mm respectively,and the difference was statistically significant(P＜0.05).Sore throat,wing of nose pain and balloon displacement were the most common adverse events,with 30.0％(3/10),50.0％(5/10)and 70.0％(7/10),respectively.Conclusion It is safe,effective and feasible to treat refractory benign upper digestive tract stricture with self-help inflatable balloon in vitro.It is worthy for clinical application.

Objective To explore the clinical characteristics,laboratory examination indicators,and auxilia-ry examination results of critically ill children with adenovirus pneumonia,screen relevant indicators with warning effects for critically ill children with adenovirus pneumonia,and construct an early identification scale for critically ill children with adenovirus pneumonia.Methods The clinical data of totally 86 children with adenovirus pneumonia admitted in the hospital from May 2021 to September 2023 were retrospectively ana-lyzed,and multivariate Logistic regression analysis was used to screen relevant indicators for the early identifi-cation of severe adenovirus pneumonia in children.The sensitivity and the specificity were analyzed using the receiver operating characteristic(ROC)curve.Experts conducted a quantitative evaluation of the weight scores of each factor,and finally an early identification scale for critically ill children with adenovirus pneumo-nia was developed.Results Among 86 children with severe adenovirus pneumonia,34 were critically ill with adenovirus pneumonia.There were statistically significant differences in the incidence of respiratory distress,respiratory distress,consciousness and behavior disorders,respiratory symptoms,cardiovascular symptoms,and neurological symptoms between the two groups(P<0.05).The differences of white blood cell count,platelet count,erythrocyte dynamic sedimentation rate,serum ferritin,serum ferritin/erythrocyte dynamic sed-imentation rate,R-glutamyltransferase,alanine aminotransferase,lactate dehydrogenase between the severe group and the critically ill group were statistically significant(P<0.05).Multivariate Logistic regression a-nalysis showed that white blood cell count,platelet count,alanine aminotransferase,serum ferritin/erythrocyte dynamic sedimentation rate and lactate dehydrogenase were all influencing factors for the progression to criti-cal illness in children with adenovirus pneumonia(P<0.05),and the ROC curve results showed that the area under the curve of the diagnostic model composed of white blood cell count,platelet count,alanine aminotrans-ferase,serum ferritin/red blood cell dynamic sedimentation rate,and lactate dehydrogenase for diagnosing crit-ical illness was 0.864,and the sensitivity and the specificity were 86.42%and 82.76%,respectively.After 25 peer experts evaluated the weight scores of various clinical manifestations and examination items,the early i-dentification scale for critically ill children with adenovirus pneumonia was finally developed.Conclusion Dur-ing clinical treatment,the clinical manifestations of children with adenovirus pneumonia can be considered in conjunction with relevant auxiliary examination results,and early identification scales can be used to determine whether children with adenovirus pneumonia are at risk of developing into critical illness.

Objective To investigate the efficacy and safety of self-help inflatable balloon in the treatment of refractory benign upper digestive tract stricture.Methods From November 2022 to February 2024,10 patients with refractory benign upper digestive tract stricture underwent self-help inflatable balloon were retrospectively analyzed.Preoperative treatment,intraoperative and postoperative complications,dysphagia score before and after surgery,wearing time of external self-help inflatable balloon,and the clinical efficacy were evaluated.Results All the 10 patients received self-help inflatable balloon treatment.No complications such as bleeding and perforation occurred in all patients during the wearing of the balloon.The placement time of the balloon was 60～180 d,and the average wearing time was 104.9 d.Before surgery,nine cases had a stricture segment length less than 2 cm,and one case had a stricture segment length of 6 cm.The dysphagia score before surgery was(3.60±0.52),and the dysphagia score after removal of the self-help inflatable balloon was(0.60±0.52),and there was statistical significance in preoperative and postoperative comparison(P＜0.05).The dysphagia score 3 months after removal of the external self-help inflatable balloon was(0.70±0.48),there was no significant difference in dysphagia score between the day after surgery and 3 months after surgery(P＞0.05).The diameter of the stricture before and after operation was(5.09±2.02)mm and(10.35±0.73)mm respectively,and the difference was statistically significant(P＜0.05).Sore throat,wing of nose pain and balloon displacement were the most common adverse events,with 30.0％(3/10),50.0％(5/10)and 70.0％(7/10),respectively.Conclusion It is safe,effective and feasible to treat refractory benign upper digestive tract stricture with self-help inflatable balloon in vitro.It is worthy for clinical application.

Objective:To investigate the mechanism of ursolic acid regulating HMGB1/TLR4 pathway in reducing intestinal barrier injury in a rat model of ulcerative colitis(UC).Methods:Rats were randomly divided into control group,model group,glycyr-rhizic acid(HMGB1 inhibitor)group,ursolic acid group and glycyrrhizic acid+ursolic acid group,with 12 rats in each group.UC rat model was induced by tritrobenzene sulfonate enema.After drug administration,body weight and disease activity index(DAI)score were performed of rats in each group;pathological morphology of colonic mucosa was detected by HE staining,the thickness of mucosa and height of villi were compared;levels of catalase(CAT),superoxide dismutase(SOD),malondialdehyde(MDA)in colon tissue,levels of serum diamine oxidase(DAO),and intestinal fatty acid binding protein(I-FABP),TNF-α,IL-18,IL-6 were detected by kits;expression levels of tight junction proteins(Claudin-1,ZO-1,Occludin)and HMGB1/TLR4 pathway proteins(HMGB1,TLR4,MyD88)in colon tissues were detected by Western blotting.Expression levels of HMGB1,TLR4 and MyD88 in colonic tissue were detected by immunohistochemistry.Results:Compared with control group,colonic mucosal tissue of model group had severe pathological injury,the body weight,mucosal thickness,villus height,CAT,SOD,Claudin-1,ZO-1 and Occludin levels in colon tis-sue were significantly reduced,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly increased(P<0.05);compared with model group,pathological injury of colonic mucosal tissue of rats in ursolic acid group,glycyrrhizic acid group and glycyrrhizic acid+ursolic acid group were reduced,body weight,muco-sal thickness,villus height,colon tissue CAT,SOD,Claudin-1,ZO-1 and Occludin levels were significantly increased,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly reduced(P<0.05);combined intervention of glycyrrhizic acid and ursolic acid could enhance the influence of ursolic acid on the above indexes(P<0.05).Conclusion:Ursolic acid can inhibit inflammation,reduce the level of oxidative stress,reduce the colonic mucosal injury of UC rats,repair the intestinal mucosal barrier function,and improve the clinical symptoms of rats,which may be achieved by down-regulating the HMGB1/TLR4 pathway.

The key link to colorectal cancer progression is that epigenetic derangements promote reprogramming of glucose metabolism.Based on many studies on the relationship between spleen being the origin of acquired constitution and epigenetics,spleen qi dispersing essence and glucose metabolism,combined with the extensive experience of traditional Chinese medicine in the treatment of colorectal cancer and the accumulation of researches on glucose metabolism,it is believed that the"epigenetic-reprogramming of glucose metabolism"pathology of colorectal cancer is the microscopic essence of the key pathogenesis of"dysfunction of spleen transforming essences".The"promoting spleen and dispersing essences"method means that"promoting spleen"to reverse epigenetic derangements and"dispersing essences"to regulate reprogramming of glucose metabolism was put forward to treat colorectal cancer.Look forward to enrich the scientific connotation of the pathogenesis of"dysfunction of spleen transforming essences",new ideas and potential empirical basis for traditional Chinese medicine intervention in colorectal cancer were provided.

Objective To analyze the death status and main causes of death among children under 5 years old in Changsha from 2016 to 2021, and to provide a scientific basis for formulating preventive measures for children's health care. Methods The data of 1 761 deaths of children under 5 years old in Changsha City from 2016 to 2021 were collected, and the mortality trend, the order of causes of death and the utilization of pre-death medical care services were retrospectively analyzed. Results The 7-day neonatal mortality, 28-day neonatal mortality, 0-1-year-old neonatal mortality, and the mortality rate of children under 5 years old (U5MR) in Changsha City from 2016 to 2021 were 0.76‰, 1.28‰, 2.41‰, and 3.86‰, respectively. All the mortality rates showed a decreasing trend (P<0.05). U5MR in males was significantly higher than that in females (P<0.05), and U5MR in rural areas was significantly higher than that in urban areas (P<0.05). The top five causes of U5MR were drowning, premature delivery or low birth weight, pneumonia, other congenital anomalies, and accidental asphyxia, respectively. The death places of children under 5 years old were mainly medical and health institutions, and 81.72% of them were treated in hospitals before death. Conclusion From 2016 to 2021, the mortality rate of children under the age of 5 in Changsha City has gradually decreased. Preventing congenital malformations, reducing preterm birth or low birth weight, improving the treatment level of pneumonia, and preventing accidents such as drowning and accidental suffocation are the key to reducing the mortality rate of children under 5 years old.