Objective:To analyze the characteristics of the injury of knee ligament and cartilage in pediatric patients after acute traumatic lateral patellar dislocation based on magnetic resonance imaging (MRI). Methods:Clinical data of 68 pediatric patients with acute traumatic lateral patellar dislocation admitted to The Second Hospital of Tangshan from September,2020 to September,2023 were retrospectively analyzed. All children underwent MRI scan on knee joint. These children were divided into partial tear group (85 cases) and complete tear group (41 cases) according to injury degree. In addition,the location and characteristic of the medial patellofemoral ligament (MPFL) injury and cartilage injury were analyzed. Results:All 126 children had MPFL injury,including 85 cases of partial tear and 41 cases of complete tear. Among the partial tears,34 cases occurred only on the patellar side,14 cases only on the femoral side,9 cases only in the middle segment,and 28 cases had multiple-site injuries. Among the complete tears,27 cases occurred only on the patellar side,7 cases only on the femoral side,4 cases only in the middle segment,and 3 cases had multiple-site injuries. The number of each degree of partial MPFL injury was higher than that of complete injury,and the difference was statistically significant (x2=7.596,10.886,P<0.05). Among the 126 children,91 cases had VMO injury,and the degree of VMO injury was positively correlated with the degree of MPFL injury (r=0.339,P=0.006). Among the 126 children with acute traumatic lateral patellar dislocation,119 cases had osteochondral injury,with a total of 174 injured sites. The sites of grade 1 injury were mainly on the patellar side,while those of grades 2,3,and 4 injuries were mainly multiple-site injuries. Conclusion:Most of acute traumatic lateral patellar dislocation complicate MPFL injury and cartilage injury in pediatric patients,which mainly focus on patellar side of injury and multiple injury. There are no differences in injury site and degree between different genders. MPFL injury mostly complicates VMO injury,which injury degree is positively correlation with MPFL.

Objective:To analyze the characteristics of the injury of knee ligament and cartilage in pediatric patients after acute traumatic lateral patellar dislocation based on magnetic resonance imaging (MRI). Methods:Clinical data of 68 pediatric patients with acute traumatic lateral patellar dislocation admitted to The Second Hospital of Tangshan from September,2020 to September,2023 were retrospectively analyzed. All children underwent MRI scan on knee joint. These children were divided into partial tear group (85 cases) and complete tear group (41 cases) according to injury degree. In addition,the location and characteristic of the medial patellofemoral ligament (MPFL) injury and cartilage injury were analyzed. Results:All 126 children had MPFL injury,including 85 cases of partial tear and 41 cases of complete tear. Among the partial tears,34 cases occurred only on the patellar side,14 cases only on the femoral side,9 cases only in the middle segment,and 28 cases had multiple-site injuries. Among the complete tears,27 cases occurred only on the patellar side,7 cases only on the femoral side,4 cases only in the middle segment,and 3 cases had multiple-site injuries. The number of each degree of partial MPFL injury was higher than that of complete injury,and the difference was statistically significant (x2=7.596,10.886,P<0.05). Among the 126 children,91 cases had VMO injury,and the degree of VMO injury was positively correlated with the degree of MPFL injury (r=0.339,P=0.006). Among the 126 children with acute traumatic lateral patellar dislocation,119 cases had osteochondral injury,with a total of 174 injured sites. The sites of grade 1 injury were mainly on the patellar side,while those of grades 2,3,and 4 injuries were mainly multiple-site injuries. Conclusion:Most of acute traumatic lateral patellar dislocation complicate MPFL injury and cartilage injury in pediatric patients,which mainly focus on patellar side of injury and multiple injury. There are no differences in injury site and degree between different genders. MPFL injury mostly complicates VMO injury,which injury degree is positively correlation with MPFL.

BACKGROUND:Observations from several clinical studies suggest a close relationship between hypertension and osteoporosis,but the causal relationship between hypertension and osteoporosis is unclear. OBJECTIVE:To determine whether there is a causal relationship between hypertension and osteoporosis,multisite bone mineral density and osteoporosis with fractures in Asian and European populations,respectively,using a comprehensive two-sample Mendelian randomized analysis. METHODS:Data of osteoporosis in Asian populations were obtained through Japan biological bank. Data of osteoporosis in European populations were obtained from UK Biobank,a British biological bank. Data of hypertension,multisite bone mineral density and osteoporosis with fractures were all from FinnGen R10 database. Inverse variance weighted method,MR-Egger regression method,weighted median method,weighted model method and simple model method were used to study the causal relationship between hypertension and osteoporosis,multisite bone mineral density and osteoporosis with fracture in Asian and European populations. Comprehensive sensitivity analysis was used to verify the robustness,heterogeneity and level pleiotropy of the results. Stsiger test was used to determine whether there was a reverse causal relationship between osteoporosis and hypertension. RESULTS AND CONCLUSION:In Asian populations,there was no significant genetic predictive causal relationship between hypertension and osteoporosis,and there was a positive causal relationship between hypertension and calcaneal bone mineral density. In European populations,hypertension had a negative causal relationship with osteoporosis,and there was no significant causal relationship between hypertension and systemic bone mineral density,calcaneal bone mineral density,forearm bone mineral density and osteoporosis with fracture. According to the stsiger test,there was no reverse causal relationship between osteoporosis,multiplesite bone mineral density,osteoporosis with fracture and hypertension in Asian and European populations. These results indicate that there is a causal relationship between hypertension and osteoporosis,that is,in Asian populations,hypertension and calcaneal bone mineral density show a positive causal relationship;in European populations,hypertension and osteoporosis show a negative causal relationship,but no reverse causal relationship.

Objective:To explore the clinical features, histopathological morphology, and differential diagnosis of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers.Methods:From 2020 to 2021, 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers diagnosed in Fujian Cancer Hospital (2 cases) and the Second Affiliated Hospital of Fujian Medical University (2 cases) were collected. Different ancillary procedures such as HE, special stains, immunohistochemistry, and in situ hybridization techniques were used to assess the histopathological features and immunophenotypes. The clinical data were collected and literature was reviewed.Results:All 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers were male. They were 32, 45, 67 and 39 years old, respectively. The main clinical manifestations were bloody phlegm, abdominal pain, fatigue and anorexia. The clinical stages at diagnosis were stage Ⅳ (3 cases) and stage Ⅱ (1 case). Cases 2 and 3 had two pathological examinations at different sites, with a total of six pathological examinations. The histomorphology showed singly scattered or nests of tumor cells in a background of abundant small lymphocytes. The tumor cells were enlarged and pleomorphic, some appeared polygonal with inconspicuous cell borders, and they were arranged in a syncytial pattern. There were megakaryocytes, multinucleated tumor cells, and a few spindle-shaped cells seen. Atypical mitosis was commonly noted. By immunohistochemistry, the tumor cells were positive for CKpan(5/6), CK8/18(4/4), CAM5.2(2/5), CK-H(0/4), CK-L(3/4), EMA(4/5), CK5/6(3/6), p63(1/6), p40(1/6), E-cadherin (4/6), SSTR2(6/6), PD-L1(5/5), LCA(0/6), vimentin(5/6), CD2 (6/6), CD23(6/6), CD35(5/6), CXCL-13(4/5) and D2-40(1/5). The Ki-67 proliferative index was 60%-95%. In situ hybridization for EBER were all positive (6/6). Special stain for reticulin showed positive staining surrounding nests of tumor cells.Conclusions:The expression of follicular dendritic cell markers in lymphoepithelioma-like carcinoma is very rare, which may be related to EBV infection. Occasionally, it can overlap with follicular dendritic cell sarcoma by morphology and immunophenotype, which can lead to misdiagnosis. Only by combining clinical information, morphological characteristics and immunophenotype can an appropriate diagnosis be made.

BACKGROUND:Observations from several clinical studies suggest a close relationship between hypertension and osteoporosis,but the causal relationship between hypertension and osteoporosis is unclear. OBJECTIVE:To determine whether there is a causal relationship between hypertension and osteoporosis,multisite bone mineral density and osteoporosis with fractures in Asian and European populations,respectively,using a comprehensive two-sample Mendelian randomized analysis. METHODS:Data of osteoporosis in Asian populations were obtained through Japan biological bank. Data of osteoporosis in European populations were obtained from UK Biobank,a British biological bank. Data of hypertension,multisite bone mineral density and osteoporosis with fractures were all from FinnGen R10 database. Inverse variance weighted method,MR-Egger regression method,weighted median method,weighted model method and simple model method were used to study the causal relationship between hypertension and osteoporosis,multisite bone mineral density and osteoporosis with fracture in Asian and European populations. Comprehensive sensitivity analysis was used to verify the robustness,heterogeneity and level pleiotropy of the results. Stsiger test was used to determine whether there was a reverse causal relationship between osteoporosis and hypertension. RESULTS AND CONCLUSION:In Asian populations,there was no significant genetic predictive causal relationship between hypertension and osteoporosis,and there was a positive causal relationship between hypertension and calcaneal bone mineral density. In European populations,hypertension had a negative causal relationship with osteoporosis,and there was no significant causal relationship between hypertension and systemic bone mineral density,calcaneal bone mineral density,forearm bone mineral density and osteoporosis with fracture. According to the stsiger test,there was no reverse causal relationship between osteoporosis,multiplesite bone mineral density,osteoporosis with fracture and hypertension in Asian and European populations. These results indicate that there is a causal relationship between hypertension and osteoporosis,that is,in Asian populations,hypertension and calcaneal bone mineral density show a positive causal relationship;in European populations,hypertension and osteoporosis show a negative causal relationship,but no reverse causal relationship.

Objective:To explore the clinical features, histopathological morphology, and differential diagnosis of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers.Methods:From 2020 to 2021, 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers diagnosed in Fujian Cancer Hospital (2 cases) and the Second Affiliated Hospital of Fujian Medical University (2 cases) were collected. Different ancillary procedures such as HE, special stains, immunohistochemistry, and in situ hybridization techniques were used to assess the histopathological features and immunophenotypes. The clinical data were collected and literature was reviewed.Results:All 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers were male. They were 32, 45, 67 and 39 years old, respectively. The main clinical manifestations were bloody phlegm, abdominal pain, fatigue and anorexia. The clinical stages at diagnosis were stage Ⅳ (3 cases) and stage Ⅱ (1 case). Cases 2 and 3 had two pathological examinations at different sites, with a total of six pathological examinations. The histomorphology showed singly scattered or nests of tumor cells in a background of abundant small lymphocytes. The tumor cells were enlarged and pleomorphic, some appeared polygonal with inconspicuous cell borders, and they were arranged in a syncytial pattern. There were megakaryocytes, multinucleated tumor cells, and a few spindle-shaped cells seen. Atypical mitosis was commonly noted. By immunohistochemistry, the tumor cells were positive for CKpan(5/6), CK8/18(4/4), CAM5.2(2/5), CK-H(0/4), CK-L(3/4), EMA(4/5), CK5/6(3/6), p63(1/6), p40(1/6), E-cadherin (4/6), SSTR2(6/6), PD-L1(5/5), LCA(0/6), vimentin(5/6), CD2 (6/6), CD23(6/6), CD35(5/6), CXCL-13(4/5) and D2-40(1/5). The Ki-67 proliferative index was 60%-95%. In situ hybridization for EBER were all positive (6/6). Special stain for reticulin showed positive staining surrounding nests of tumor cells.Conclusions:The expression of follicular dendritic cell markers in lymphoepithelioma-like carcinoma is very rare, which may be related to EBV infection. Occasionally, it can overlap with follicular dendritic cell sarcoma by morphology and immunophenotype, which can lead to misdiagnosis. Only by combining clinical information, morphological characteristics and immunophenotype can an appropriate diagnosis be made.

Dextran 40 is a commonly used pharmaceutical excipient and can be used as formulations of dry powder for injection. But it has antigenic properties that can trigger severe allergic reactions. Therefore, injections containing the excipient dextran 40 may have additional safety risks that are not easily recognized in the clinic. Dextran 40-associated allergic reactions may also interfere with the diagnosis of certain diseases and limit the choice of therapeutic drugs. Revision of the relevant instructions and improvement of the clinical dosing process can help reduce the risk of injections containing the excipient dextran 40 in clinical use. Physicians and pharmacists should expand their clinical and pharmacological thinking to evaluate the antigenicity of the excipient dextran 40 as an independent influence factor in the rational and safe use of medication. Identification individual cases of adverse events caused by this excipient and taking measures to minimize adverse events caused by this excipient in different drugs can help effectively reduce the risk of drug safety of the relevant formulations.

The occurrence and development of malignant tumors are closely related to immune checkpoint receptors, and tumor cells can evade immune surveillance by activating the immune checkpoint pathway. T cell immunoglobulin and ITIM domain(TIGIT) is an inhibitory receptor expressed on lymphocytes, which can inhibit the function of natural killer cells(NK) and T cells through a variety of mechanisms, making tumor cells escape from the surveillance of the immune system. This article made a systematic review on the research progress of the immunosuppressive mechanism of TIGIT, and reviewed the research progress of the immunosuppressive mechanism of TIGIT.

Objective: To assess the current situation and related factors of the knowledge, attitude and behavior toward sexual abuse prevention among primary school students in Luzhou City, Sichuan Province, so as to provide a reference basis for the development of sexual abuse prevention education for primary school students. Methods: A total of 4 563 primary school students in Luzhou City were sampled from December 2023 to January 2024 by stratified cluster sampling, and self administered questionnaires were conducted. The binary Logistic regression analysis was used to analyze related factors of the knowledge, attitude and behavior toward sexual abuse prevention. Results: The qualified rates of knowledge, behavior and attitude among primary school students towards sexual abuse prevention in Luzhou were 76.2%, 21.3%, and 90.2 %, respectively. The binary Logistic regression showed that males ( OR=0.66, 95%CI =0.56-0.78), attending rural schools ( OR=0.77, 95%CI =0.64-0.92), left behind status ( OR=0.66, 95%CI =0.53-0.81), and household registration in Lu County ( OR=0.57, 95%CI =0.46-0.70) and Gulin County ( OR=0.70, 95%CI =0.57-0.86) had lower qualified rates of the knowledge of sexual abuse prevention among primary school students ( P < 0.05 ); while qualified knowledge of sexual abuse prevention was positively associated with grade ( OR =3.05-18.81); attending rural schools ( OR=0.82, 95%CI =0.70-0.95) and not having received education on prevention of sexual abuse ( OR=0.55, 95%CI = 0.47-0.64) had lower qualified rates of the behavior of sexual abuse prevention among primary school students ( P <0.05); household registration in Lu County ( OR=0.73, 95%CI =0.58-0.92) and not having received education on prevention of sexual abuse ( OR=0.33, 95%CI =0.26-0.40) had lower qualified rates of the educational attitudes of sexual abuse prevention among primary school students ( P <0.05). Conclusions The qualified rates of knowledge and behavior of sexual abuse prevention among primary school students in Luzhou City needs to be improved. Health education regarding sexual abuse prevention might help enhance primary school students awareness and skills of sexual abuse prevention.

Objective:To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock.Methods:This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment.Results:A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value ( AUC=0.54, 95% CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion:EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.