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 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 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 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.

Objective:To investigate the effect of tumor deposits on the prognosis and lymph node staging in patients with gastric cancer.Methods:The clinicopathological data of 907 patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from Jan to Dec 2016 were retrospectively analyzed. According to the pathological diagnosis, the patients were divided into tumor deposits positive group (121 cases) and tumor deposits negative group (786 cases), and the relationship between tumor deposits and clinicopathological features and prognosis was analyzed.Results:Tumor deposits were found in 121 patients among 907 cases. Univariate analysis showed that tumor deposits were correlated with pT stage, pN stage, pTNM stage, tumor diameter, nerve invasion and vascular invasion (all P<0.05). Multivariate analysis showed that pT stage ( P<0.001), pN stage ( P=0.002), pTNM stage ( P=0.001), tumor diameter ( P=0.033),nerve invasion ( P=0.017), vascular invasion ( P=0.011) were the independent influencing factors of positive tumor deposits. The prognosis of patients with tumor deposits was worse than those without ( χ2=77.869, P<0.001). By univariate analysis, age, tumor location, size, pT stage, pN stage, pTNM stage, tumor thrombus, nerve invasion, tumor deposits and number affected prognosis (all P<0.05). Multivariate analysis showed that age, pT stage, pN stage, pTNM stage, nerve invasion, vascular invasion and the number of tumor deposits were independent prognostic factors (all P<0.05). By stratified analysis tumor deposits were found to have statistical difference in N0~N3a stage (all P<0.05). Conclusion:Tumor deposits is an independent risk factor affecting the prognosis of gastric cancer patients.

Humans ; Gastrointestinal Microbiome ; Diabetes Mellitus, Type 2/complications* ; Cholelithiasis

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, and the new cases of HCC in China account for more than half of the global cases every year. High incidence mortality and limited treatment methods are the main challen-ges for HCC prevention and treatment in China. Immunotherapy has brought new treatment options and hope of prolonging the survival to patients with advanced HCC. Data from the IMbrave 150 study published in the New England Journal of Medicine in May 2020 showed that the median overall survival of all patients was 19.2 months, and the median overall survival of the Chinese subgroup was 24.0 months, which suggested significant efficacy in prolongating patient survival and controlling tumor. Interven-tional therapy has been playing an important role in the treatment of HCC, and more and more clinical studies have adopted systematic therapy combined with interventional therapy. Interven-tional therapy and systematic therapy have synergistic efficacy which lead to significant clinical efficacy. The authors introduce the diagnosis and treatment of an advanced HCC patient undergoing interventional therapy combined with bevacizumab plus attilizumab treatment, which lead to signifi-cant clinical efficacy of tumor controlling.

Cyclophilin A (CypA) is a member of peptidyl prolylisomerases (PPIase) family. CypA is best known as a ubiquitously distributed intracellular protein. It has also been shown to be secreted by cells in response to inflammatory stimuli and oxidative stress. Extracellular CypA (eCypA) interacts with CD147 to initiate inflammatory responses via recruiting leucocytes into inflamed tissue. Recombinant CypA was expressed in Escherichia coli and then purified using Superdex 75™ 16/60. The results of Real-time PCR and ELISA showed that the expression levels of proinflammatory cytokines, such as IL-1β, secreted by eCypA stimulated BMDM were significantly up-regulated, indicating that eCypA played an important role in promoting inflammatory responses. In addition, anti-CypA antibody was prepared using purified CypA protein for therapeutic evaluation in a mouse model of LPS-induced acute lung inflammation. Antibody-treated mice showed reduced lung injury and the expression levels of IL-1β in the lung tissue and blood were decreased significantly, indicating that anti-CypA antibody exerted a potent anti-inflammatory activity. Our findings provide a potential therapeutic antibody for inflammation-mediated diseases.

Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.

Objective To compare the clinical efficacy of posterior pedicle screw fixation through Wiltse paraspinal approach and posterior traditional open approach in the treatment of thoracolumbar fracture and dislocation.Methods A retrospective case control study was performed based on the clinical data of 40 patients with thoracolumbar fracture and dislocation admitted between January 2013 and January 2016.All the surgeries were performed through posterior midline incision,and they were divided into two groups according to different approaches.Patients in Group A received pedicle screw fixation through Wiltse paraspinal approach while Group B received fixed pedicle screw through open surgery.Group A was composed of 12 males and 8 females,aged 21-60 years [(41.5 ±9.6)years].Group B was composed of 13 males and 7 females,aged 18-58 years [(39.1 ± 13.1) years].The same surgical procedures were adopted in spinal decompression,reduction,and the spinal vertebral interbody bone graft and fusion surgery in the two groups.Operation duration,intraoperative blood loss,postoperative drainage volume,visual analogue scale (VAS),spinal canal patency at the last follow-up,percentage of postoperative injury of vertebral height recovery,and Cobb angle were compared.CT and MRI were used to evaluate postoperative paravertebral muscle atrophy,and American spinal injury association (ASIA) impairment scale was used to evaluate neurological function assessment.Results All patients were followed up for 9-33 months,with (19.3 ± 5.6) months for Group A and (22.5 ± 4.9) months for Group B (P ＞ 0.05).The operation duration was (240.5 ± 38.3) min in Group A and (258.5 ± 43.7) min in Group B (P ＞ 0.05).The intraoperative blood loss was (525.0 ± 168.2) ml in Group A,less than (770.0 ± 269.2) ml in Group B (P ＜ 0.05).Postoperative drainage volume was (190.1 ± 78.9) ml in Group A,less than (281.7 ± 122.3) ml in Group B (P ＜ 0.05).VAS score 24 hours after operation and at the last follow-up in Group A was (6.4 ± 1.0) points and (1.6 ± 0.5) points,respectively,better than those in Group B [(7.8 ± 0.7) points and (2.2 ± 0.4) points] (P ＜ 0.05).No significant differences were observed in terms of spinal canal patency at the last follow-up,percentage of postoperative injury of vertebral height recovery,and Cobb angle [Group A:(85.3 ± 3.7) ％,(85.5 ± 2.7) ％,and (4.7 ± 1.2)°;GroupB:(85.8±1.8)％,(88.8 ±1.3)％,and (5.3 ±1.5)°] (P＞0.05).In terms of MRI evaluation score of postoperative paravertebral muscle atrophy,Group A reported better results than Group B [(2.1 ± 0.6) points vs.(1.2 ± 0.6) points] (P ＜ 0.05).At the last follow-up,there were 7,5,6,1 and 1 patients in Group A,while 6,6,5,2 and 1 patients in Group B at ASIA grades A,B,C,D and E (P ＞ 0.05).Within the same group,significant difference was observed between the preoperative data and that at the last follow-up in terms of postoperative VAS score,spinal canal patency,percentage of injury of vertebral height,Cobb angle,and ASIA impairment scale (P ＜ 0.05).Conclusion For thoracolumbar fracture and dislocation,compared with traditional open approach,posterior pedicle screw fixation through Wiltse paraspinal approach can effectively restore the vertebral body height and spinal canal patency and can reduce the intraoperative bleeding,postoperative drainage,postoperative back pain,and paravertebral lesion.