Objective:To investigate the clinical efficacy of posterior midline incision combined with anteromedial approach in the treatment of complex olecranon fracture-dislocation.Methods:A retrospective analysis was performed on 26 patients (15 males and 11 females) with olecranon fracture-dislocation who were admitted from January 2020 to January 2024, including 5 cases of anterior transolecranon fracture-dislocation (2 cases of upper ulnar-radial joint dislocation), 21 cases of posterior transolecranon fracture-dislocation (5 cases of them were accompanied by upper ulnar-radial joint dislocation). Among them, there were 13 cases of traffic accidents, 7 cases of falling from heights, and 6 cases of walking falls. The average age is 45.1±15.3 years old (21-84 years old).Results:The operation time was 151.2±41.9 minutes, average tourniquet time was 93.7±22.6 minutes, and the intraoperative blood loss was 76.2±20.2 ml. The average follow-up was 16(12, 23) months, and the VAS score decreased significantly and the MEPS score increased significantly over time. At the last follow-up, the VAS score was 2(1, 2), and the MEPS score was 86.5±10.3, with 16 cases excellent, 7 cases good, and 3 cases medium, with an excellent rate of 89%. The range of motion of flexion-extension and pronation-supination were 119.3°±13.5°and 138.6°±15.2° respectively. Complications included 16 cases of ectopic ossification, of which 4 patients with significant effects on elbow function underwent surgical release 3-6 months after surgery. 1 case of ulnar nerve injury symptoms improved after emergency ulnar nerve release, and 1 case of elbow subluxation due to inaccurate coronoid process reduction and fixation. There were no serious complications such as vascular injury, internal fixation failure, fracture nonunion, and incision infection.Conclusion:The posterior midline incision combined with anteromedial approach can effectively treat complex olecranon fracture-dislocation and meet the requirements of early postoperative elbow rehabilitation.

Objective:To explore the psychological vulnerability characteristics of patients after percutaneous coronary intervention (PCI) based on symptom network analysis, and to provide evidence for maintining their psychological health.Methods:Using a cross-sectional survey method, from October 2023 to March 2024, a convenience sampling approach was employed to conduct a questionnaire survey among patients who underwent percutaneous coronary intervention (PCI) in the general ward of the Cardiology Department at Peking University Third Hospital. The survey involved a general information questionnaire and Mental Vulnerability Questionnaire. The R language was used to construct a symptom network to describe the relationship between each symptom of patients′psychological vulnerability, and its centrality index was calculated.Results:A total of 260 post-PCI patients were enrolled, including191 males and 69 females, with a mean age of (62.38 ± 12.91) years and a total psychological vulnerability score of (47.25 ± 13.18). Multiple linear regression analysis showed that the level of mental vulnerability was higher in patients with female gender ( β = 0.207, P = 0.001) and higher number of comorbidities/past history ( β = 0.126, P = 0.039). In the symptom network analysis, the symptoms with the highest node strength, tight centrality, and mediator centrality were "You often feeling unwell" ( rs = 1.25, rc = 0.003 45, rb = 2.61), "You always in a bad mood" ( rs = 1.15) and "You often have anxiety attacks" ( rs = 1.13) were second only to "You often feeling unwell" in the center of intensity. Conclusions:The core symptom of psychological vulnerability in post-PCI patients is "You often feeling unwell", and mental symptoms are in a more central position. Nursing staff should take mental symptoms as the target of intervention, and strengthen the holistic care for patients′physical-psychological-mental symptoms, so as to effectively reduce the level of psychological vulnerability of the patients, and to maintain their psychological health.

Objective:To investigate the clinical efficacy of posterior midline incision combined with anteromedial approach in the treatment of complex olecranon fracture-dislocation.Methods:A retrospective analysis was performed on 26 patients (15 males and 11 females) with olecranon fracture-dislocation who were admitted from January 2020 to January 2024, including 5 cases of anterior transolecranon fracture-dislocation (2 cases of upper ulnar-radial joint dislocation), 21 cases of posterior transolecranon fracture-dislocation (5 cases of them were accompanied by upper ulnar-radial joint dislocation). Among them, there were 13 cases of traffic accidents, 7 cases of falling from heights, and 6 cases of walking falls. The average age is 45.1±15.3 years old (21-84 years old).Results:The operation time was 151.2±41.9 minutes, average tourniquet time was 93.7±22.6 minutes, and the intraoperative blood loss was 76.2±20.2 ml. The average follow-up was 16(12, 23) months, and the VAS score decreased significantly and the MEPS score increased significantly over time. At the last follow-up, the VAS score was 2(1, 2), and the MEPS score was 86.5±10.3, with 16 cases excellent, 7 cases good, and 3 cases medium, with an excellent rate of 89%. The range of motion of flexion-extension and pronation-supination were 119.3°±13.5°and 138.6°±15.2° respectively. Complications included 16 cases of ectopic ossification, of which 4 patients with significant effects on elbow function underwent surgical release 3-6 months after surgery. 1 case of ulnar nerve injury symptoms improved after emergency ulnar nerve release, and 1 case of elbow subluxation due to inaccurate coronoid process reduction and fixation. There were no serious complications such as vascular injury, internal fixation failure, fracture nonunion, and incision infection.Conclusion:The posterior midline incision combined with anteromedial approach can effectively treat complex olecranon fracture-dislocation and meet the requirements of early postoperative elbow rehabilitation.

Objective:To explore the psychological vulnerability characteristics of patients after percutaneous coronary intervention (PCI) based on symptom network analysis, and to provide evidence for maintining their psychological health.Methods:Using a cross-sectional survey method, from October 2023 to March 2024, a convenience sampling approach was employed to conduct a questionnaire survey among patients who underwent percutaneous coronary intervention (PCI) in the general ward of the Cardiology Department at Peking University Third Hospital. The survey involved a general information questionnaire and Mental Vulnerability Questionnaire. The R language was used to construct a symptom network to describe the relationship between each symptom of patients′psychological vulnerability, and its centrality index was calculated.Results:A total of 260 post-PCI patients were enrolled, including191 males and 69 females, with a mean age of (62.38 ± 12.91) years and a total psychological vulnerability score of (47.25 ± 13.18). Multiple linear regression analysis showed that the level of mental vulnerability was higher in patients with female gender ( β = 0.207, P = 0.001) and higher number of comorbidities/past history ( β = 0.126, P = 0.039). In the symptom network analysis, the symptoms with the highest node strength, tight centrality, and mediator centrality were "You often feeling unwell" ( rs = 1.25, rc = 0.003 45, rb = 2.61), "You always in a bad mood" ( rs = 1.15) and "You often have anxiety attacks" ( rs = 1.13) were second only to "You often feeling unwell" in the center of intensity. Conclusions:The core symptom of psychological vulnerability in post-PCI patients is "You often feeling unwell", and mental symptoms are in a more central position. Nursing staff should take mental symptoms as the target of intervention, and strengthen the holistic care for patients′physical-psychological-mental symptoms, so as to effectively reduce the level of psychological vulnerability of the patients, and to maintain their psychological health.

OBJECTIVE To evaluate the cost-effectiveness of the first-line treatment using the combination therapy of sugemalimab and chemotherapy (hereinafter referred to as the "combination therapy") for advanced esophageal squamous cell carcinoma (ESCC) with high programmed death-ligand 1 (PD-L1) expression from the perspective of the Chinese healthcare system. METHODS A partitioned survival model was constructed based on data from the GEMSTONE-304 study. The model cycle was set at 3 weeks,with a study duration of 10 years and a discount rate of 5％. The primary output parameters of the model included total costs,quality-adjusted life year (QALY),incremental costs,and incremental cost-effectiveness ratio (ICER). Cost-utility analysis was employed to assess the economic feasibility of the combination therapy compared to chemotherapy alone. The robustness of the base case analysis results was evaluated through univariate sensitivity analysis,probabilistic sensitivity analysis,and scenario analysis. RESULTS The ICER of the combination therapy compared to chemotherapy alone was 288430.35 yuan/QALY,significantly exceeding the willingness-to-pay (WTP) threshold of 173354.52 yuan/QALY which was set at 1.94 times the per capita gross domestic product (GDP) in 2023. The price of sugemalimab was the primary factor influencing the ICER. When the WTP threshold was set at 1.94 times the per capita GDP (173354.52 yuan/QALY),the probability of the combination therapy being cost-effective compared to chemotherapy alone was 0. The combination therapy only became cost-effective compared to chemotherapy alone when the price of the drug dropped to 6107.41 yuan per box (600 mg). CONCLUSIONS From the perspective of the Chinese healthcare system,the combination therapy for first-line treatment of advanced ESCC with high PD-L1 expression is not cost-effective;the combination therapy is cost-effective when the price of sugemalimab decreas by 50.65％.

Neurogenesis decline in hippocampal dentate gyrus (DG) participates in stress-induced depressive-like behaviors, but the underlying mechanism remains poorly understood. Here, we observed low-expression of NOD-like receptor family pyrin domain containing 6 (NLRP6) in hippocampus of stress-stimulated mice, being consistent with high corticosterone level. NLRP6 was found to be abundantly expressed in neural stem cells (NSCs) of DG. Both Nlrp6 knockout (Nlrp6^-/-) and NSC-conditional Nlrp6 knockout (Nlrp6CKO) mice were susceptible to stress, being more likely to develop depressive-like behaviors. Interestingly, NLRP6 was required for NSC proliferation in sustaining hippocampal neurogenesis and reinforcing stress resilience during growing up. Nlrp6 deficiency promoted esophageal cancer-related gene 4 (ECRG4) expression and caused mitochondrial dysfunction. Corticosterone as a stress factor significantly down-regulated NLRP6 expression, damaged mitochondrial function and suppressed cell proliferation in NSCs, which were blocked by Nlrp6 overexpression. ECRG4 knockdown reversed corticosterone-induced NSC mitochondrial function and cell proliferation disorders. Pioglitazone, a well-known clinical drug, up-regulated NLRP6 expression to inhibit ECRG4 expression in its protection against corticosterone-induced NSC mitochondrial dysfunction and proliferation restriction. In conclusion, this study demonstrates that NLRP6 is essential to maintain mitochondrial homeostasis and proliferation in NSCs, and identifies NLRP6 as a promising therapeutic target for hippocampal neurogenesis decline linked to depression.

Objective:To observe the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in the inner limiting membrane (ILM) of diabetic retinopathy (DR) with macular edema, and analyze the correlation between VEGF and AQP4 expression.Methods:A cross-sectional study. From September 2019 to September 2020, 38 eyes of 38 patients with DR and idiopathic macular hole (iMH) who underwent vitrectomy (PPV) combined with ILM stripping at the Hangzhou campus of The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. Among them, there were 25 males and 13 females who aged 37-76 years old, average age was 59±10 years old; All eye included 15 right eyes and 23 left eyes. iMH and DR included 9 eyes in 9 cases and 29 eyes in 29 cases, respectively, and they were divided into iMH group and DR group. The DR group was divided into DME group and no DME group according to whether it was accompanied by diabetic macular edema (DME), with 14 eyes and 15 eyes respectively. After the stripped ILM tissue was fixed, immunofluorescence analysis was performed to obtain a picture of the fluorescence mode of AQP4 and VEGF, and the fluorescence intensity value of VEGF and AQP4 was measured by Image J software. The differences of VEGF and AQP4 immunofluorescence values in the specimens between groups were compared by one-way analysis of variance. The correlation between the fluorescence intensity of AQP4 and the fluorescence intensity of VEGF was analyzed by Pearson correlation analysis.Results:The average fluorescence intensity valuesof VEGF and AQP4 in ILM specimens of DME group, no DME group and iMH group were 38.96±7.53, 28.25±3.12, 30.07±4.84 and 49.07±8.73, 37.96±6.45, 38.08±5.04, respectively. The average fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DME group was significantly higher than that of the no DME group and iMH group, and the difference was statistically significant ( F=13.977, 9.454; P<0.05). The average fluorescence intensity values of VEGF and AQP4 on IML specimens in the DR group were 33.80±7.91, 43.76±9.44, respectively. The results of Pearson correlation analysis showed that the fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DR group was significantly positively correlated ( r=0.597, P=0.003). Conclusions:The expressions of VEGF and AQP4 in ILM of eyes with DR and DME are significantly increased compared with those without DME. The expression of VEGF and AQP4 in ILM of eyes with DR is positively correlated.

OBJECTIVE： To investigate the effects of crystal form on in vivo and in vitro behavior of Astilbin nanosuspensions （AT-NS）. METHODS： AT-NS1 and AT-NS2 were prepared by precipitation method and miniaturized media milling method respectively. The particle size and polydispersity index （PDI） were determined by laser particle size analyzer. X-ray diffraction （XRD）， scanning electron microscopy （SEM）， HPLC and paddle method were used to analyze and compare the structure characteristics， appearance morphology and in vitro dissolution of AT raw material， AT-NS1 and AT-NS2. Totally 15 healthy male SD rats were randomly divided into AT raw material， AT-NS1 and AT-NS2 group， with 5 rats in each group. They were given relevant medicine suspension 120 mg/kg （using water as solvent） intragastrically； blood samples  were collected from orbit before medication （0 min） and 5， 10， 20， 30， 60， 120， 240， 480 min after medication. Using rutin as internal standard， HPLC method was used to determine plasma concentration of AT in rats. Pharmacokinetic parameters were calculated by using DAS 2.0 software and then compared. RESULTS： The particle sizes of AT-NS1 and AT-NS2 were （212.48±0.32） nm and （226.36±2.29） nm， respectively； PDI were 0.129 3±0.026 3 and 0.254 7±0.012 4. XRD analysis showed AT-NS1 was amorphous， and AT-NS2 was crystalline. Diffraction peaks of both were different from those of AT raw material. SEM analysis showed that AT-NS1 and AT-NS2 were similar in morphology， and they were spherical and uniform in size； AT raw material was lump with large particle size and different sizes. Results of dissolution tests showed that accumulative dissolution of AT raw material， AT-NS1 and AT-NS2 were 4.54％， 35.01％， 12.22％ at 1 h； accumulative dissolution of them were 24.01％， 81.14％， 64.69％ at 12 h； accumulative dissolution of them were 36.04％， 84.47％， 85.86％ at 24 h， respectively. Results of pharmacokinetic study showed， compared with AT raw material group， cmax and AUC0-∞ of AT-NS1 and AT-NS2 groups as well as t1/2z of AT-NS1 group were increased significantly， while tmax of AT-NS1 group was significantly reduced significantly （P＜0.05）. Compared with AT-NS2 goup， cmax， AUC0-∞ and t1/2z of AT-NS1 group were increased significantly， while tmax was reduced significantly （P＜0.05）. CONCLUSIONS： When AT is prepared into NS， dissolution in vitro and oral absorption in vivo of AT are increased significantly. In a short time， the dissolution/absorption of amorphous NS is faster than crystalline NS.

Objective To explore the effect of robot-assisted gait training on pelvis kinematics and the walking function of hemiplegic stroke survivors.Methods Thirty stroke survivors with hemiplegia were randomly divided into a treatment group and a control group,each of 15.Both groups were given routine clinical medication and rehabilitation training,while the treatment group was additionally provided with 20 minutes of robot-assisted gait training a day,6 d/wk for 8 weeks.Before and after the treatment,all of the patients' pelvis kinematics were assessed using 10 m walking speed (MWS),the timed up and go test (TUGT) and functional ambulation categorization (FAC).Results Before the treatment there were no significant differences between the two group in any of the measurements.After the treatment,significant improvement was observed in both groups in the vertical displacement and rotation and tilt angles of the pelvis while walking,with significantly more improvement in the treatment group than in the control group.There was also significant improvement in the average walking speed,TUGT time and FAC score of both groups,with significantly more improvement in the treatment group.Conclusion Robot-assisted gait training can significantly improve the pelvis control and walking ability of hemiplegic stroke survivors.

Objective To estimate the influence of ADAR1 gene,which is considered to be responsible for the pathogenesis of dyschromatosis symmetrica hereditaria,on Wnt1 1 expression and tyrosinase activity.Methods Some cultured HaCaT cells were equally divided into four groups:control group remaining untreated,three experimental groups transfected with three different ADAR1-specific shRNAs respectively.Then,Western blot was performed to quantify the expression of Wnt11 protein in HaCaT cells so as to select the most potent shRNA.Some human A375 melanoma cells were cocultured with untransfected HaCaT cells (normally expressing ADAR1 and Wnt1 1 proteins) or HaCaT cells transfected with the selected specific shRNA (lowly expressing ADAR1 and Wnt11 proteins).Thereafter,cell appearance was observed using inverted microscopy at 24,48 and 72 hours,and tyrosinase activity was estimated at 48 hours.Results As Western blot showed,the expression of Wnt 11 protein was significantly lower in the three ADAR1-silenced experimental groups than in the control group.The number of dendritic protrusions at the junction sites between HaCaT cells and A375 cells was significantly decreased,together with a significant reduction in tyrosinase activity (absorbance value:0.0168 ± 0.0069 vs.0.0490 ± 0.0132,P ＜0.01),in A375 cells cocultured with transfected HaCaT cells compared with those cocultured with normal control HaCaT cells.Conclusion ADAR1 gene silencing in HaCaT cells can attenuate the expression of Wnt11 protein,and affect tyrosinase activity in A375 cells.