OBJECTIVE: To investigate the surgical technique and preliminary effectiveness of closed reduction and internal fixation (CRIF) using antegrade elastic intramedullary nailing (ESIN) via a novel approach through the proximal radius for treating distal radius metaphyseal-diaphyseal junction (DRMDJ) fractures in children. METHODS: A retrospective analysis was conducted on 34 children with DRMDJ fractures who met the selection criteria and were treated between January 2020 and June 2023. There were 21 boys and 13 girls, aged 6-14 years (mean, 8.2 years). Injury causes included falls in 11 cases and sports-related trauma in 23 cases. Twenty-six cases were associated with ipsilateral distal ulnar fractures. All patients had failed initial closed reduction in the outpatient clinic. The time from injury to operation ranged from 1 to 15 days (mean, 4 days). All patients underwent CRIF using antegrade ESIN inserted via a novel approach at the proximal one-third of the radius. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Fracture reduction was assessed immediately after operation on anteroposterior and lateral X-ray films for residual translation and angulation. Wrist function was evaluated using the modified Mayo wrist score. RESULTS: Surgery was successfully completed in all 34 children. CRIF with ESIN failed in 2 cases with associated ipsilateral distal ulnar fractures, requiring conversion to open reduction of the ulna. Operation time ranged from 15 to 56 minutes (mean, 21 minutes). Intraoperative fluoroscopy frequency ranged from 5 to 21 times (mean, 7 times). Immediate postoperative X-ray films showed residual translation of 0-15% on anteroposterior view and 0-10% on lateral view, and residual angulation of 0°-5° on both anteroposterior and lateral views. All children were followed up 6-18 months (mean, 12 months). There was no complication such as neurovascular injury, incision infection, or limitation of forearm rotation. Follow-up X-ray films showed no fracture displacement, implant loosening, delayed union, or nonunion. Fracture healing time ranged from 4 to 8 weeks (mean, 6 weeks). Implants were removed at 4-6 months postoperatively (mean, 5 months). At last follow-up, all fractures had achieved anatomic or near-anatomic healing. The modified Mayo wrist score ranged from 80 to 100 (mean, 94), with 27 excellent and 7 good results, yielding an excellent and good rate of 100%. CONCLUSION CRIF using antegrade ESIN via a novel approach through proximal radius is a safe and effective treatment for pediatric DRMDJ fractures, associated with few postoperative complications and excellent restoration of wrist function.
Humans ; Child ; Female ; Male ; Fracture Fixation, Intramedullary/instrumentation* ; Adolescent ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Bone Nails ; Treatment Outcome ; Fracture Healing ; Diaphyses/surgery* ; Radius/surgery* ; Operative Time ; Closed Fracture Reduction/methods* ; Ulna Fractures/surgery*

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Objective To explore the prognostic impact of Qili Qiangxin capsules(QLQX)in patients with ST-segment elevation myocardial infarction(STEMI).Methods Retrospective collecting the clinical data of STEMI patients treated at PingAn Hospital affiliated to Hebei Medical University from January 2020 to January 2022,divided into QLQX group and non-QLQX group according to treatment plan.Follow-up patients for 1 year,with the main endpoint being major adverse cardiovascular and cerebrovascular events(MACCEs)at 30 d and 1 year;The secondary endpoints were cardiogenic death,myocardial reinfarction,emergency coronary revascularization,stroke,and major bleeding at 30 d and 1 year,as well as severe STEMI complications(30 d),re-admission due to heart failure(1 year),and all-cause mortality(1 year).Results A total of 210 STEMI patients were included(125 in the QLQX group and 85 in the non QLQX group).Univariate or Kaplan Meier analysis showed that the MACCE,cardiogenic death,malignant arrhythmia at 30 d,myocardial reinfarction,re-admission due to heart failure,and all-cause mortality rates in the QLQX group were significantly lower than those in the non QLQX group at 30 d and 1 year(P＜0.05),while there were no significant differences in the incidence of other observed endpoint events between the two groups(P＞0.05).In addition,QLQX may be a protective factor for MACCEs in STEMI patients(30 d:HR=0.157,95％CI 0.032 to 0.756,P=0.021;1 year:HR=0.208,95％CI 0.087 to 0.497,P=0.014).Conclusion QLQX adjuvant therapy may improve MACCEs in STEMI patients.

Aim To investigate the effects of naringenin on atherosclerotic plaque extracellular matrix remodeling and plaque stability.Methods Murine vascular smooth muscle cells were isolated and treated with various doges of naringenin.ApoE-/-mice were fed with high-fat diet and received naringenin by lavage for 16 weeks.Intraplaque nec-rotic core,contents of collagen and fibrous cap thickness were measured by Sirius red-Haematoxylin staining.Elastin was detected by Van Gieson staining.Matrix metalloproteinase(MMP)activity was determined by gelatin zymography and fluorescence-gelatin staining.Results Naringenin(50 μmol/L)increased signal tansducer and activator of transciption 6(STAT6)phosphorylation and promoted tissue inhibitor of metalloproteinase-3(TIMP-3)expression by 3.1-fold(P＜0.001).After naringenin(80 mg/kg)treatment,compared with the control group,the area of plaque necrotic core in aor-tic root decreased by 53％(P＜0.01),the thickness of fibrous caps increased by nearly 50％(P＜0.05),and the degree of elastic fiber degradation decreased.At the same time,naringenin promoted the expression of TIMP-3 in plaques,and corre-spondingly reduced the activity of MMP in plaques.Lentivirus mediated inhibition of TIMP-3 expression in vivo could reduce the protective effect of naringenin on plaque stability.Conclusion Naringin can increase the expression of TIMP-3 in smooth muscle cells,improve the composition of extracellular matrix,and promote the stability of atherosclerotic plaque.

Aim To study the effect of maternal high-fat diet during pregnancy on endothelial to mesenchymal transition of aortic vessels in adult offspring.Methods The pregnant mice were randomly divided into normal diet group and high-fat diet group,and the offspring mice were fed normally for 16 weeks after the mother gave birth.Western blot and RT-qPCR were used to detect the expression and transcription of related proteins,and immunofluorescence and im-munohistochemical staining were used for pathological analysis.Results Compared with the offspring of maternal nor-mal diet during pregnancy,the expressions of vascular inflammatory factors,macrophage infiltration,monocyte-endothelium adhesion were significantly increased in the offspring of maternal high-fat diet(OHF)during pregnancy(P＜0.05).Vas-cular endothelial nitric oxide synthase(eNOS)activity,nitric oxide(NO)level were dramatically reduced(P＜0.05).Immunofluorescence results showed reduced endothelial cell marker CD31 and increased mesenchymal marker α-smooth muscle actin(α-SMA)in OHF.Western blot analysis further confirmed the results,which showed that maternal high fat diet reduced vascular endothelial-cadherin(VE-cadherin)and CD31 and increased α-SMA and Vimentin in the offspring(P＜0.05).The maternal high fat diet increased the extracellular matrix protein disposition and transforming growth factor beta(TGF-β)/Smad signaling in endothelium(P＜0.05).Moreover,the maternal high fat diet reduced Kruppel-like factor 2(KLF2)expression by 76％in mRNA level and 59％in protein level(P＜0.05).Conclusion Maternal high-fat diet during pregnancy lead to a transition of endothelial to mesenchyme in the offspring aorta.The results provide a clue for prevention of vascular disease in early stage.

Objective　To explore the application of factorial design in field trapping experiments for flies, and to provide more ideas for screening the best fly control method. Methods　A 2×2 factorial design was used to analyze the main effects of the height of the fly cage (hanging fly cage, standing fly cage) and the type of bait (commercial bait, smelly tofu bait), and the interaction between the two factors. The fly trapping methods were divided into four combinations: hanging fly cage and commercial bait, hanging fly cage and smelly tofu bait, standing fly cage and commercial bait, standing fly cage and smelly tofu bait. The experiment was repeated 7 times for each combination and carried out according to the National Vector Biological Surveillance Implementation Plan. The best fly trapping method was identified by factorial design analysis of variance. Results　A total of 2 296 flies were trapped in this study, with a cumulative deployment of 28 traps in the field, resulting in an average total density of 82.0 flies per cage. Among them, the number of flies attracted by the combination of standing fly cage and smelly tofu was the largest, accounting for 44.16% (1 014/2 296) of the total number of flies caught, with an average fly density of 144.8 flies per trap. This was followed by the combination of hanging fly cage and smelly tofu, hanging fly trap and commercial bait, and standing fly cage and commercial bait, accounting for 42.73% (981/2 296), 8.71% (200/2 296), and 4.40% (101/2 296) of the total, with average fly densities of 140.1, 28.6, and 14.4 flies per trap, respectively. The differences in field fly density among different trapping methods were statistically significant (F=49.441, P<0.001), and the differences in fly population composition were also statistically significant (χ2=259.980, P<0.001). The main effect of trap height was not significant (F=0.223, P=0.641), while the main effect of bait type was significant (F=147.206, P<0.001), and the interaction effect between trap height and bait type was not significant (F=0.894, P=0.354). Conclusions　Compared with the single-factor design method, the factorial design method can not only analyze the main effects of each factor but also the interactions between the factors. The combination of standing fly cage and smelly tofu is preferred to have a better fly control effect.

ObjectiveIn the treatment of acute gouty arthritis （AGA）， western medicine is mostly used for anti-inflammatory and analgesic purposes to control the blood uric acid level， but some patients are still at risk of poor control and recurrent attacks. Chinese medicinal prescriptions， potent in resisting inflammation and relieving pain， are able to stabilize the blood uric acid level， reduce acute attacks， and improve the clinical efficacy of western medicine. However， there is a lack of evidence to support their use as evidence-based medicine. This study employed network Meta-analysis （NMA） to evaluate the efficacy and safety of common Chinese medicinal prescriptions in the treatment of AGA， aiming to provide evidence-based medical evidence for the clinical use of Chinese medicinal prescriptions in the treatment of AGA. MethodChinese and English databases were searched for prospective cohort studies and randomized controlled trials （RCTs） on Chinese medicinal prescriptions against AGA from database inception to December 1， 2022. Stata software and Review Manager were used for statistical analysis. ResultForty-four papers with 3 564 cases involved were included in the current NMA. In terms of reducing blood uric acid， the cumulative probability results showed that Mahuang Lianyao Chixiaodou Tang showed optimal efficacy （87.60%）. In terms of relieving joint pain， Danggui Niantongtang and Guizhi Shaoyao Zhimutang showed optimal efficacy （92.00% and 82.30%）. In terms of improving erythrocyte sedimentation rate （ESR）， Simiaowan was superior to other prescriptions （87.00%）. In terms of reducing C-reactive protein （CRP）， Simiaowan and Baihutang modified with Guizhitang showed superior efficacy （76.00% and 66.10%）. In terms of safety， except for the basic treatment group， Mahuang Lianyao Chixiaodou Tang had the lowest probability of adverse events， and Danggui Niantongtang had the highest probability of adverse reactions during treatment. According to the results of cluster analysis， Mahuang Lianyao Chixiaodou Tang and Simiaowan are effective and safe. ConclusionAccording to the results of NMA， Chinese medicinal prescriptions can assist in the treatment of AGA and improve the effectiveness of western medicine. For patients with AGA， clinicians can choose Mahuang Lianyao Chixiaodou Tang or Simiaowan as an auxiliary drug for routine western medicine treatment.

Objective:To identify tooth number abnormalities on pediatric panoramic radiographs based on deep learning.Methods:Eight hundred panoramic radiographs of children aged 4 to 11 years meeting the inclusion and exclusion criteria were selected and randomly assigned by writing programs in Python (version 3.9) to the training set (480 images), verification set (160 images) and internal test set (160 images), taken in Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between November 2012 to August 2020. And all panoramic radiographs of children aged 4 to 11 years taken in the First Outpatient Department of Peking University School and Hospital of Stomatology from June 2022 to December 2022 were collected as the external test set (907 images). All of the 1 707 images were obtained by operators to determine the outline and to label the tooth position of each deciduous tooth, permanent tooth, permanent tooth germ and additional tooth. The deep learning model with ResNet-50 as the backbone network was trained on the training set, validated on the verification set, tested on the internal test set and external test set. The images of test sets were divided into two categories according to whether there was abnormality of tooth number, to calculate sensitivity, specificity, positive predictive value and negative predictive value, and then divided into four types of extra teeth and missing permanent teeth both existed, extra teeth existed only, missing permanent teeth existed only, and normal teeth number, to calculate Kappa values. Results:The sensitivity, specificity, positive predictive value and negative predictive value were 98.0%, 98.3%, 99.0% and 96.7% in the internal test set, and 97.1%, 98.4%, 91.9% and 99.5% in the external test set respectively, according to whether there was abnormality of tooth number. While images were divided into four types, the Kappa value obtained in the internal test set was 0.886, and that in the external test set was 0.912. Conclusions:In this study, a deep learning-based model for identifying abnormal tooth number of children was developed, which could identify the position of additional teeth and output the position of missing permanent teeth on the basis of identifying normal deciduous and permanent teeth and permanent tooth germs on panoramic radiographs, so as to assist in diagnosing tooth number abnormalities.

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.

BACKGROUND: Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients. METHODS: An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level. RESULTS: The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching. CONCLUSION: Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications. REGISTRATION NCT05677815 at https://clinicaltrials.gov/ .
Female ; Humans ; Adult ; Middle Aged ; Aged ; Cohort Studies ; COVID-19/complications* ; Pandemics ; Retrospective Studies ; Postoperative Complications/epidemiology*