Objective:To evaluate the effect of open reduction and internal fixation versus humeral head replacement on postoperative recovery of shoulder joint function in a population of patients with comminuted fractures of the proximal humerus. Methods:This study was a case-control study that retrospectively analyzed data from 80 patients with comminuted fractures of the proximal humerus who underwent surgical treatment at the Department of Orthopedics at Xi'an Gaoxin Hospital from January 2020 to December 2023. The patients were divided into two groups based on the surgical method: the control group ( n = 45) received open reduction and internal fixation, while the observation group ( n = 35) underwent humeral head replacement. Surgery-related indexes, as well as therapeutic effect ratings, shoulder joint mobility, and shoulder joint function 3 months post-surgery, were compared between the two groups. Additionally, the incidence of complications occurring during the treatment was also compared between the two groups. Results:In the observation group, the intraoperative blood loss, surgery duration, postoperative drainage amount, and length of hospital stay were (186.92 ± 28.04) mL, (68.89 ± 10.12) minutes, (57.89 ± 11.25) mL, and (10.18 ± 2.41) days, respectively, all of which were significantly lower than those in the control group, which were (218.23 ± 35.57) mL, (98.26 ± 15.34) minutes, (73.65 ± 13.68) mL, and (12.35 ± 2.92) days ( t = 4.27, 9.78, 5.51, 3.55, all P < 0.05). There was no statistically significant difference in the therapeutic effect between the two groups 3 months post-surgery [97.14% (34/35) vs. 95.56% (43/45), χ2 = 0.04, P > 0.05]. At 3 months post-surgery, the angles of forward elevation, external rotation, and internal rotation in the observation group were (95.42 ± 7.88)°, (61.37 ± 6.56)°, and (74.38 ± 5.01)°, respectively, while in the control group they were (93.68 ± 7.75)°, (60.42 ± 6.87)°, and (73.75 ± 4.92)°, respectively. The differences were not statistically significant between the two groups ( t = -0.98, -0.62, -0.56, all P > 0.05). At 3 months post-surgery, the shoulder function score in the observation group was (73.46 ± 9.15), which was not significantly different from that in the control group [(71.75 ± 8.66), t = -0.85, P > 0.05]. The incidence of complications in the observation group was 2.86% (1/35), which was significantly lower than that in the control group [22.22% (10/45), χ2 = 4.70, P = 0.030). Conclusions:For patients with comminuted fractures of the proximal humerus, both open reduction and internal fixation and humeral head replacement can achieve good shoulder joint function recovery. However, humeral head replacement is more advantageous than open reduction and internal fixation during the perioperative period.

Objective:To investigate the role of reactive astrocytes expressing aromatase(ARO)in the penumbra during ischemic stroke.Methods:A mouse model of middle cerebral artery occlusion(MCAO/R)was prepared using the suture method.Western blot and immunofluorescence staining were used to observe the expression of ARO in the penumbra after ischemia reperfusion.We generated a glial fibrillary acidic protein promoter-driven aromatase knock-out(GFAP-ARO-KO)mouse model in vivo.Neurologic impairment scores,rotarod test,grip strength test and adhesive removal test on the plantar surface of the paw were performed after MCAO/R modeling.Results:In wild type mice,the expression of ARO was significantly increased in astrocytes in the penumbra after MCAO/R(P<0.01).Compared to the control group,the expression of ARO in the GFAP-ARO-KO group was significantly reduced in astrocytes in the penumbra after MCAO/R.And loss of ARO increased cerebral infarction volume and aggravated sensorimotor impair-ment.Conclusion:After ischemic stroke,reactive astrocytes in the penumbra highly express ARO and play a protective role in post-ischemia reperfusion injury.

Objective:To investigate the association between single nucleotide polymorphism (SNP) of the protein phosphatase 1 regulatory subunit 1B( PPP1R1B) gene and schizophrenia in the Han population of northern Henan province. Methods:Utilizing Psychiatric Genomics Consortium 3 (PGC3) data, the SNPs of PPP1R1B gene which were significantly associated with schizophrenia were screened.Subsequently, totally 1 721 schizophrenia patients and 6 726 healthy controls from the Han population in northern Henan province were recruited for further analysis. The SNP rs907094, located within the PPP1R1B gene was validated, and the clinical symptoms of 386 schizophrenia patients were evaluated using the positive and negative syndrome scale (PANSS). Additionally, expression quantitative trait loci (eQTL) association analysis was conducted to explore the relationship between the rs907094 polymorphism and PPP1R1B gene expression.The PLINK v1.9, Genetic Power Calculater, SPSS 20.0 softwares were used for data analysis. Results:Significant differences in genotype AA, AG, GG(schizophrenia group: AA, 489(28.4%); AG, 848(49.3%); GG, 384(22.3%); control group: AA, 1 450(21.6%); AG, 3 386(50.3%); GG, 1 890(28.1%), χ2=45.418, P<0.05) and allele frequency(schizophrenia group: A, 1 826(53.1%); G, 1 616(46.9%); control group: A, 6 286(46.7%); G, 7 166(53.3%), χ2=43.877, P<0.05) were observed for SNP rs907094 between the schizophrenia group and control group. Individuals carrying allele A were identified to have a higher risk of developing schizophrenia compared to those carrying allele G ( OR=1.288, 95% CI=1.195-1.388). Furthermore, the genotype PPP1R1B gene was found to be associated with the clinical features of schizophrenia. A statistically significant difference was observed in the excitement/hostility factor between AA and GG patients with rs907094 (13.62±5.65, 15.54±4.66)( P<0.05). Additionally, significant differences were noted in the cognitive factor scores between AA and GA genotypes (17.76±5.58, 19.43±5.73)( P<0.05). Conclusions:In the Han population from northern Henan province, the rs907094 polymorphism of the PPP1R1B gene is associated with schizophrenia.And the specific locus may be implicated in arousal/hostility symptoms and cognitive dysfunction.

Objective:To investigate the role of reactive astrocytes expressing aromatase(ARO)in the penumbra during ischemic stroke.Methods:A mouse model of middle cerebral artery occlusion(MCAO/R)was prepared using the suture method.Western blot and immunofluorescence staining were used to observe the expression of ARO in the penumbra after ischemia reperfusion.We generated a glial fibrillary acidic protein promoter-driven aromatase knock-out(GFAP-ARO-KO)mouse model in vivo.Neurologic impairment scores,rotarod test,grip strength test and adhesive removal test on the plantar surface of the paw were performed after MCAO/R modeling.Results:In wild type mice,the expression of ARO was significantly increased in astrocytes in the penumbra after MCAO/R(P<0.01).Compared to the control group,the expression of ARO in the GFAP-ARO-KO group was significantly reduced in astrocytes in the penumbra after MCAO/R.And loss of ARO increased cerebral infarction volume and aggravated sensorimotor impair-ment.Conclusion:After ischemic stroke,reactive astrocytes in the penumbra highly express ARO and play a protective role in post-ischemia reperfusion injury.

The term"heat stroke"originates from the integration of modern traditional Chinese and Western medicine.In clinical practice,the complementary advantages of the two medical systems can significantly enhance the clinical diagnosis and treatment level of heat stroke.Through comprehensively analyzes the traditional Chinese medicine(TCM)nomenclature for heat stroke,proposing that heat stroke is a type of sunstroke characterized by intense and pure yang nature,specifically referring to symptoms caused directly or indirectly by hot weather.It can be referenced under the categories of Zhongye,Shuwen,Yinshu/Yangshu,Shujue,and Shufeng for treatment.The article reviews the TCM diagnostic and therapeutic thinking for heat stroke,summarizing its etiology and pathogenesis,including summerheat directly entering the Yangming,heat entering the heart and nutrient-blood aspects,evil combined with water(post-emergency),dual injury of qi and fluid(post-mild recovery),and phlegm-stasis obstructing collaterals(post-severe recovery).Based on years of clinical experience and combining the different clinical manifestations of heat stroke with TCM's four diagnostic methods,the article proposes a treatment plan that integrates Chinese and Western medicine,combining disease differentiation with syndrome differentiation.The main syndromes summarized include high fever with spasms(Yangming heat excess syndrome),diarrhea(Yangming fu syndrome-intestinal sweating),high fever with coma(heat entering the heart-nutrient syndrome),high fever with convulsions(extreme heat generating wind syndrome),heat stroke-induced coagulopathy(heat entering the blood aspect syndrome),edema after fluid resuscitation(Taiyang water retention syndrome),recovery phase(dual injury of qi and fluid syndrome),and sequelae(phlegm-stasis obstructing collaterals syndrome).For treatment,Baihu Jia Renshen decotion combined with Zengye Chengqi decotion is used for nourishing yin and increasing fluids,relaxing tendons,and stopping spasms for Yangming heat excess syndrome;Baihu decotion combined with Zengye decotion for clearing summerheat and nourishing yin for Yangming fu syndrome-intestinal sweating;Qingying decotion for clearing the nutrient aspect and cooling blood,penetrating heat,and nourishing yin for heat entering the heart-nutrient syndrome;Lingjiao Gouteng decotion for clearing heat and cooling the liver,extinguishing wind,and calming spasms for extreme heat generating wind syndrome;Wuling powder for draining and eliminating water retention for Taiyang water retention syndrome;Wang's Qing Shu Yiqi decotion for clearing summerheat and reducing fever,benefiting qi,and generating fluids for dual injury of qi and fluid syndrome;and Sanjia powder for clearing residual heat,resolving phlegm,and removing stasis from collaterals for phlegm-stasis obstructing collaterals syndrome.Starting from TCM theory and linking it with practice,the article combines Western disease differentiation with TCM syndrome differentiation,aiming to provide new ideas for the clinical treatment of heat stroke.

Objective To compare the efficacy and safety of erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in preventing acute post-surgical pain syndrome(PSP)of breast cancer.Methods The following databases,both domestic and international,including Embase,Cochrane Library,Web of Science,PubMed,CNKI,VIP,Wanfang,and Sinomed,were searched via computer to gather clinical randomized controlled trials(RCTs)on ESPB and TPVB for breast cancer patients.The included literature was evaluated using the Cochrane bias risk assessment tool to assess quality,and meta-analysis was performed using Review Manager 5.4 software and Stata 17.0 software.Results This study comprised 14 RCTs,with a total of 1079 patients,including 540 ESPB patients and 539 TPVB patients.The analysis results indicated that there was a significant difference in pain scores during postoperative rest between ESPB and TPVB during 3-4 h(I2=53%,SMD=0.36,95%CI:0.07-0.65,P=0.020)and 5-6 h(I2=80%,SMD=0.53,95%CI:0.05-1.01,P=0.030),with TPVB being superior to ESPB.However,there was no significant difference in pain scores during postoperative rest between ESPB and TPVB at 1-2 h(I2=75%,SMD=0.28,95%CI:-0.03-0.60,P=0.080),7-8 h(I2=89%,SMD=0.24,95%CI:-0.47-0.94,P=0.510),12 h(I2=90%,SMD=0.1,95%CI:-0.40-0.60,P=0.690),24 h(I2=78%,SMD=0.33,95%CI:-0.04-0.70,P=0.080),and 48 h(I2=85%,SMD=-0.05,95%CI:-0.52-0.42,P=0.830).For the pain score during postoperative exercise,there was a significant difference between ESPB and TPVB during 3-4 h(I2=0,SMD=0.29,95%CI:0.09-0.48,P=0.004),7-8 h(I2=48%,SMD=0.37,95%CI:0.00-0.73,P=0.050),and 48 h(I2=0,SMD=0.21,95%CI:0.03-0.39,P=0.020),with TPVB being su-perior to ESPB.There was no significant difference between ESPB and TPVB at 1-2 h(I2=89%,SMD=0.42,95%CI:-0.19-1.03,P=0.180),5-6 h(I2=90%,SMD=0.29,95%CI:-0.67-1.24,P=0.560),12 h(I2=81%,SMD=0.25,95%CI:-0.22-0.72,P=0.300),and 24 h(I2=83%,SMD=0.39,95%CI:-0.10-0.89,P=0.120).There was a statistical difference in the operation time of nerve blocks between the two methods,with ESPB taking less time than TPVB(P＜0.001).However,there was no statistical difference in opioid consumption within 24 h after surgery,incidence of nausea and vomiting,and the first PCIA press time(all P＞0.05).Conclusions Compared to ESPB,TPVB tends to result in a decreased pain score after breast cancer surgery,but it also took longer to perform.There was no significant difference be-tween the two methods in terms of opioid consumption at 24 h after surgery,incidence of nausea and vomiting and the first PCIA press time.

Objective:To explore the association between serum selenium levels and total cancer risk in humans.Methods:A systematic search was conducted for Chinese and English literature on the association between selenium and cancer risk published up to December 2023 in the Chinese National Knowledge Infrastructure (CNKI), Wanfang, PubMed, EMbase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases by using “neoplasms” “selenium” “prospective-studies” (both in English and Chinese) as keywords. The meta-analysis was performed using a random-effect model. The linear dose-response relationship was analyzed using a generalized least squares regression model, and the non-linear dose-response relationship was analyzed using a restricted cubic spline regression model. Publication bias was assessed by funnel plots and Egger′s regression asymmetry test.Results:A total of 12 prospective studies were included from 16 408 articles retrieved, including seven studies from Europe, four from America, and one from Asia, with a total of 4 586 cancer cases reported. Meta-analysis revealed an inverse association between baseline serum selenium levels and total cancer risk ( RR=0.68, 95% CI: 0.57-0.82, P=0.000). Furthermore, serum selenium was found to have a protective effect on both the incidence ( RR=0.66, 95% CI: 0.53-0.84, P=0.001) and mortality ( RR=0.70, 95% CI: 0.50-0.98, P=0.035) of total cancer. The inverse association between serum selenium and the incidence of total cancer was more pronounced in populations with low baseline serum selenium levels ( RR=0.65, 95% CI: 0.48-0.89, P=0.007). Additionally, dose-response meta-analysis showed that for every 10 μg/L increase in baseline serum selenium concentration, there was a 26% reduction in incidence of total cancer ( RR=0.74, 95% CI: 0.46-0.83, P=0.229) and a 6% reduction in mortality of total cancer ( RR=0.94, 95% CI: 0.86-0.96, P=0.229). Conclusion:Serum selenium is negatively associated with the incidence and mortality of total cancer.

Objective:To investigate the predictive value of different obesity indicators for colorectal cancer (CRC) risk in different gender populations.Methods:This observational study was conducted within the Kailuan Study (Registration Number: ChiCTR-TNC-11001489). From July 2006 to October 2007, a total of 101,510 employed and retired individuals underwent health examinations, including gastrointestinal disease screening, hematological tests, and questionnaires, at Kailuan General Hospital and its 10 affiliated hospitals. After excluding those with incomplete data, 93,606 participants were included in this study and divided into male (74 852) and female (18 754) groups. CRC incidence was collected through physical examinations and questionnaires every two years. Each participant's follow-up period began at the time of the questionnaire and ended upon CRC diagnosis, death, or December 31, 2021. Body Mass Index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were quartiled (Q1, Q2, Q3, Q4), with Q1 serving as the control group. After adjusting for traditional risk factors such as age, total cholesterol, triglycerides, diabetes, hypertension, smoking status, alcohol consumption, and physical exercise, Cox regression models were used to calculate the correlations between BMI, waist circumference, WHR, WHtR, and CRC incidence in both male and female populations.Results:The age of all patients was (51±12) years, BMI was (25.06±3.49) kg/m 2, waist circumference was (86.94±9.97) cm, hip circumference was (97.30±8.81) cm, WHR was 0.89±0.07, and WHtR was 0.52±0.06.Female participants had significantly lower BMI, waist circumference, WHR, and WHtR compared to males, with statistically significant differences (all P<0.05). The mean follow-up duration for all participants was 15.01 (14.10±2.66) years, during which 718 CRC cases were identified, including 626 males (0.83%) and 92 females (0.49%). Cox proportional hazards models for males showed that CRC risk increased with waist circumference from Q3 (HR=1.43, 95%CI: 1.13-1.79, P=0.003) to Q4 (HR=1.45,95%CI: 1.14-1.82, P=0.002). Similarly, CRC risk increased with WHR from Q3 (HR=1.22, 95%CI: 1.01-1.53, P=0.007) to Q4 (HR=1.43, 95%CI: 1.14-1.79, P=0.002) and with WHtR from Q3 (HR=1.37, 95%CI: 1.08-1.74, P=0.009) to Q4 (HR=1.68, 95%CI: 1.33-2.12, P<0.001). For females, CRC risk increased with waist circumference from Q2 (HR=2.37, 95%CI: 1.20-4.67, P=0.012) to Q3 (HR=2.42, 95%CI: 1.21-4.84, P=0.013) but decreased in Q4 ( HR=2.08, 95%CI: 1.02-4.25, P=0.043). CRC risk increased significantly with WHR from Q2 (HR=2.20, 95%CI: 1.11-4.39, P=0.024) to Q3 (HR=2.89, 95%CI: 1.48-5.67, P=0.002) in females but was not statistically significant in Q4 ( P=0.074). Among females, CRC risk also increased significantly with WHtR in Q2 (HR=2.30, 95% CI: 1.16-4.56, P=0.017) and Q4 (HR=2.64, 95%CI: 1.32-5.29, P=0.006). There were no statistically significant differences in CRC risk associated with BMI in either male or female populations (both P>0.05). Conclusion:Waist circumference, WHR, and WHtR were better predictors of CRC risk than BMI in both male and female populations.

Objective:To investigate the association between single nucleotide polymorphism (SNP) of the protein phosphatase 1 regulatory subunit 1B( PPP1R1B) gene and schizophrenia in the Han population of northern Henan province. Methods:Utilizing Psychiatric Genomics Consortium 3 (PGC3) data, the SNPs of PPP1R1B gene which were significantly associated with schizophrenia were screened.Subsequently, totally 1 721 schizophrenia patients and 6 726 healthy controls from the Han population in northern Henan province were recruited for further analysis. The SNP rs907094, located within the PPP1R1B gene was validated, and the clinical symptoms of 386 schizophrenia patients were evaluated using the positive and negative syndrome scale (PANSS). Additionally, expression quantitative trait loci (eQTL) association analysis was conducted to explore the relationship between the rs907094 polymorphism and PPP1R1B gene expression.The PLINK v1.9, Genetic Power Calculater, SPSS 20.0 softwares were used for data analysis. Results:Significant differences in genotype AA, AG, GG(schizophrenia group: AA, 489(28.4%); AG, 848(49.3%); GG, 384(22.3%); control group: AA, 1 450(21.6%); AG, 3 386(50.3%); GG, 1 890(28.1%), χ2=45.418, P<0.05) and allele frequency(schizophrenia group: A, 1 826(53.1%); G, 1 616(46.9%); control group: A, 6 286(46.7%); G, 7 166(53.3%), χ2=43.877, P<0.05) were observed for SNP rs907094 between the schizophrenia group and control group. Individuals carrying allele A were identified to have a higher risk of developing schizophrenia compared to those carrying allele G ( OR=1.288, 95% CI=1.195-1.388). Furthermore, the genotype PPP1R1B gene was found to be associated with the clinical features of schizophrenia. A statistically significant difference was observed in the excitement/hostility factor between AA and GG patients with rs907094 (13.62±5.65, 15.54±4.66)( P<0.05). Additionally, significant differences were noted in the cognitive factor scores between AA and GA genotypes (17.76±5.58, 19.43±5.73)( P<0.05). Conclusions:In the Han population from northern Henan province, the rs907094 polymorphism of the PPP1R1B gene is associated with schizophrenia.And the specific locus may be implicated in arousal/hostility symptoms and cognitive dysfunction.

Objective:To investigate the distribution of pathogens and changes in serum levels of pyruvate kinase isozyme type M2 (PKM2) and Galectin-3 in patients with severe trauma complicated by ventilator-associated pneumonia (VAP).Methods:A total of 139 patients with severe trauma and underwent mechanical ventilation in Zhangjiakou First Hospital from February 2022 to February 2024 were selected as the study subjects. They were divided into the VAP group (57 cases) and non- VAP group (82 cases) based on whether they developed VAP. The distribution of pathogenic bacteria in the VAP group was analyzed. Enzyme-linked immunosorbent assay (ELISA) method was applied to determine the expression levels of serum PKM2 and Galectin-3. Multivariate Logistic regression was applied to analyze the influencing factors of VAP in patients with severe trauma. Receiver operator characteristic (ROC) curve was applied to analyze the diagnostic value of serum PKM2 and Galectin-3 levels for severe trauma complicated by VAP.Results:Seventy-one strains of pathogenic bacteria were isolated from 57 patients in the VAP group, mainly including Gram positive bacteria (36.62%), Gram negative bacteria (59.15%), and fungi (4.23%). Among them, Gram positive bacteria were mainly Staphylococcus epidermidis and Staphylococcus aureus, Gram negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumoniae, and fungi were mainly tropical Candida and Candida albicans. The proportion of history of diabetes, the proportion of eating through nasogastric tube, the proportion of trauma severity score ≥ 16 and the levels of serum PKM2 and Galectin-3 in the VAP group were higher than those in the non- VAP group: 54.39%(31/57) vs. 32.93%(27/82), 82.46%(47/57) vs. 52.44%(43/82), 66.67%(38/57) vs. 24.39%(20/82), (32.46 ± 7.28) μg/L vs. (24.25 ± 6.17) μg/L, (3.26 ± 0.75) ng/L vs. (2.39 ± 0.61) ng/L, there were statistical differences ( P<0.05). Serum PKM2, Galectin-3, history of diabetes, nasal feeding mode and trauma severity score were the influencing factors of severe trauma patients complicated by VAP ( P<0.05). The area under the curve (AUC) of serum PKM2, Galectin-3, and their combination in predicting severe trauma complicated by VAP was 0.90, and the combination of the two was superior to their respective individual diagnoses ( Zcombination - PKM2 = 2.00, Zcombination - Galectin-3 = 1.99, P = 0.046, 0.047), its sensitivity and specificity were 92.98% and 84.15%, respectively. Conclusions:The distribution of urinary tract pathogens in patients with severe trauma complicated by VAP is mainly Gram negative bacteria, and serum PKM2 and Galectin-3 levels are obviously increased in patients with severe trauma complicated by VAP . The combination of the two has higher diagnostic value for severe trauma complicated by VAP and certain clinical application value.