Objective:To compare the biomechanical differences among modular total sacral prosthesis, integrated total sacral prosthesis and screw-rod system for lumbosacral reconstruction after total sacrectomy by finite element analysis.Methods:Three finite element models of reconstruction after total sacrectomy were established: six-rod plus anterior column, integrated total sacral prosthesis, and modular total sacral prosthesis. A vertical load of 600 N was applied to the L 3 vertebra, and the bilateral acetabula were fixed in all degrees of freedom to restrict their movement, simulating a bipedal standing posture. The maximum stress, stress distribution on the iliac screws, stress distribution on the longitudinal rods, the shift-down displacement of the L 5 vertebra, and the stress direction on the contact surface between the prosthesis and the ilium on all implant components (including prosthesis, screws, and connecting rods) were compared. Results:Finite element analysis results show that the average maximum stress of the six-rod plus anterior column reconstruction on all implant instrumentation was 217.9±10.2 MPa, the integrated total sacral prosthesis reconstruction was 185.7±21.1 MPa, and the modular total sacral prosthesis reconstruction was 157.4±31.2 MPa. The differences were statistically significant ( F=12.357, P<0.001). Among them, the difference between the modular total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction was statistically significant ( P<0.001), while the difference between the modular total sacral prosthesis reconstruction and the integrated total sacral prosthesis reconstruction was not statistically significant ( P=0.051). The maximum stress on the iliac bone screws and longitudinal connecting rods: for the six-rod plus anterior column reconstruction, it was 157.2 MPa and 105.4 MPa respectively; for the integrated total sacral prosthesis reconstruction, it was 59.2 MPa and 97.8 MPa respectively; for the modular total sacral prosthesis reconstruction, it was 58.4 MPa and 35.6 MPa respectively. The distance of L 5 vertebral body downward displacement: for the six-rod plus anterior column reconstruction, it was 1.05±0.06 mm; for the integrated total sacral prosthesis reconstruction, it was 0.34±0.02 mm; for the modular total sacral prosthesis reconstruction, it was 0.40±0.05 mm. The difference was statistically significant ( F=357.730, P<0.001), among which the differences between the modular total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction and that between the integrated total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction were all statistically significant ( P<0.05), while the difference between the modular total sacral prosthesis reconstruction and the integrated total sacral prosthesis reconstruction was not statistically significant ( P=0.145). The stress on the iliac bone contact surface of the integrated total sacral prosthesis was 34.2° and manifested as shear force; the stress on the iliac bone contact surface of the modular total sacral prosthesis was 88.9° and manifested as compressive stress. Conclusions:This modular total sacral prosthesis exhibits lower peak stress compared with the integrated total sacral prosthesis and screw-rod system. The spinal stability of the modular total sacral prosthesis is comparable to that of the integrated total sacral prosthesis and superior to that of the screw-rod system.

Objective To investigate the clinical efficacy of the"dynamic and static combination"approach in the treatment of Hepple Ⅰ-Ⅲ type osteochondral lesions of the talus(OLT),utilizing external ankle shaking,pulling,and poking manipulations in conjunction with ankle brace fixation.Methods A total of 82 patients diagnosed with OLT,who sought treatment at four hospitals between June 2022 and December 2023,were included in the study.Both the experimental and control groups received ankle immobilization using braces through-out the treatment period.The control group was administered Voltaren Emulgel topically twice daily(morning and evening),with each treatment course lasting 30 days,for a total of one course.The experimental group received additional therapeutic intervention involving shaking,pulling,and poking manipulations,conducted twice weekly,with the same duration and number of treatment courses as the control group.Follow-up assessments were scheduled at 2 weeks,4 weeks,and 2 months post-treatment.Outcome measures included the pain rating index(PRI),visual analogue scale(VAS)for pain intensity,current pain intensity(PPI),American Orthopaedic Foot & Ankle Society(AOFAS)ankle and hindfoot scores,proprioceptive function,and the size of OLT.Results During the longitudinal assessment conducted at 2-week,4-week,and follow-up intervals,the experimental group exhibited superior clinical outcomes compared to the control group,with statistically significant decreases in PRI,PPI,and AOFAS scores(all P＜0.05).VAS scores showed progressive improvement over time,with significant intergroup differences observed at both the 4-week and follow-up assessments(P＜0.05).Biomechanical analysis performed post-intervention indicated improved kinematic repositioning accuracy in the experimental group,as reflected by significantly reduced active-passive error angles(P＜0.05).Importantly,measurements of OLT area revealed notable therapeutic effects in the experimental group(P＜0.05),whereas no statistically significant changes were observed in the control group throughout the study period(all P＞0.05).Conclusions Under the guidance of the"dynamic and static combination"concept,the integration of shaking,pulling,and poking manipu-lation with conventional Western medicine-based conservative treatment for OLT demonstrates more pronounced advantages in alleviating pain,improving ankle joint function,restoring proprioception,facilitating lesion recovery,and enhancing overall quality of life.

Objective To analyze the value of abnormal expression of serum alpha fetoprotein variant 3(AFP-L3)and β2 microglobulin(β2-MG)in predicting complications after interventional surgery in patients with liver cancer.Methods Clinical information of totally 92 patients with liver cancer who underwent inter-ventional surgery in the hospital from January 2020 to December 2023 were retrospectively collected and the patients were divided into complication group(33 cases)and non-complication group(59 cases)according to whether complications occurred after interventional surgery.The levels of AFP-L3 and β2-MG were detected respectively.Multivariate Logistic regression was used to analyze the the factors influencing the occurrence of complications in patients with liver cancer.Receiver operating characteristic(ROC)curve was used to evaluate the val-ue of the levels of AFP-L3 and β2-MG to predict complications in patients with liver cancer.Results Compared with the non-complication group,the proportion of patients with a history of diabetes,positive hepatitis B vi-rus(HBV)-DNA,poorly differentiated histology,and the levels of AFP-L3 and β2-MG were higher in the complication group(P＜0.05),and the course of liver cancer was longer(P＜0.05).Multivariate Logistic re-gression analysis showed that the levels of AFP-L3 and β2-MG were independent risk factors for complications after interventional surgery in patients with liver cancer.The area under the curve(AUC)of AFP-L3 and β2-MG levels in predicting complications after interventional surgery in patients with liver cancer were 0.874 and 0.854,respectively,with sensitivity of 89.77％and 74.79％,and specificity of 87.21％and 84.82％,respec-tively.The cut off values were 92.281 μg/L and 4.430 mg/L,respectively.The AUC of the combination of AFP-L3 and β2-MG levels in predicting postoperative complications was 0.910,which was significantly better than the predictive value of the single indicator(P＜0.05).Conclusion High levels of serum AFP-L3 and β2-MG may be independent risk factors for complications after interventional surgery in patients with liver canc-er.The combined detection of the two serum indicators has higher predictive value for postoperative complica-tions.It provides a new means to evaluate complications in patients with liver cancer after interventional sur-gery.

Objective To investigate the clinical efficacy of the"dynamic and static combination"approach in the treatment of Hepple Ⅰ-Ⅲ type osteochondral lesions of the talus(OLT),utilizing external ankle shaking,pulling,and poking manipulations in conjunction with ankle brace fixation.Methods A total of 82 patients diagnosed with OLT,who sought treatment at four hospitals between June 2022 and December 2023,were included in the study.Both the experimental and control groups received ankle immobilization using braces through-out the treatment period.The control group was administered Voltaren Emulgel topically twice daily(morning and evening),with each treatment course lasting 30 days,for a total of one course.The experimental group received additional therapeutic intervention involving shaking,pulling,and poking manipulations,conducted twice weekly,with the same duration and number of treatment courses as the control group.Follow-up assessments were scheduled at 2 weeks,4 weeks,and 2 months post-treatment.Outcome measures included the pain rating index(PRI),visual analogue scale(VAS)for pain intensity,current pain intensity(PPI),American Orthopaedic Foot & Ankle Society(AOFAS)ankle and hindfoot scores,proprioceptive function,and the size of OLT.Results During the longitudinal assessment conducted at 2-week,4-week,and follow-up intervals,the experimental group exhibited superior clinical outcomes compared to the control group,with statistically significant decreases in PRI,PPI,and AOFAS scores(all P＜0.05).VAS scores showed progressive improvement over time,with significant intergroup differences observed at both the 4-week and follow-up assessments(P＜0.05).Biomechanical analysis performed post-intervention indicated improved kinematic repositioning accuracy in the experimental group,as reflected by significantly reduced active-passive error angles(P＜0.05).Importantly,measurements of OLT area revealed notable therapeutic effects in the experimental group(P＜0.05),whereas no statistically significant changes were observed in the control group throughout the study period(all P＞0.05).Conclusions Under the guidance of the"dynamic and static combination"concept,the integration of shaking,pulling,and poking manipu-lation with conventional Western medicine-based conservative treatment for OLT demonstrates more pronounced advantages in alleviating pain,improving ankle joint function,restoring proprioception,facilitating lesion recovery,and enhancing overall quality of life.

Objective:To compare the biomechanical differences among modular total sacral prosthesis, integrated total sacral prosthesis and screw-rod system for lumbosacral reconstruction after total sacrectomy by finite element analysis.Methods:Three finite element models of reconstruction after total sacrectomy were established: six-rod plus anterior column, integrated total sacral prosthesis, and modular total sacral prosthesis. A vertical load of 600 N was applied to the L 3 vertebra, and the bilateral acetabula were fixed in all degrees of freedom to restrict their movement, simulating a bipedal standing posture. The maximum stress, stress distribution on the iliac screws, stress distribution on the longitudinal rods, the shift-down displacement of the L 5 vertebra, and the stress direction on the contact surface between the prosthesis and the ilium on all implant components (including prosthesis, screws, and connecting rods) were compared. Results:Finite element analysis results show that the average maximum stress of the six-rod plus anterior column reconstruction on all implant instrumentation was 217.9±10.2 MPa, the integrated total sacral prosthesis reconstruction was 185.7±21.1 MPa, and the modular total sacral prosthesis reconstruction was 157.4±31.2 MPa. The differences were statistically significant ( F=12.357, P<0.001). Among them, the difference between the modular total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction was statistically significant ( P<0.001), while the difference between the modular total sacral prosthesis reconstruction and the integrated total sacral prosthesis reconstruction was not statistically significant ( P=0.051). The maximum stress on the iliac bone screws and longitudinal connecting rods: for the six-rod plus anterior column reconstruction, it was 157.2 MPa and 105.4 MPa respectively; for the integrated total sacral prosthesis reconstruction, it was 59.2 MPa and 97.8 MPa respectively; for the modular total sacral prosthesis reconstruction, it was 58.4 MPa and 35.6 MPa respectively. The distance of L 5 vertebral body downward displacement: for the six-rod plus anterior column reconstruction, it was 1.05±0.06 mm; for the integrated total sacral prosthesis reconstruction, it was 0.34±0.02 mm; for the modular total sacral prosthesis reconstruction, it was 0.40±0.05 mm. The difference was statistically significant ( F=357.730, P<0.001), among which the differences between the modular total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction and that between the integrated total sacral prosthesis reconstruction and the six-rod plus anterior column reconstruction were all statistically significant ( P<0.05), while the difference between the modular total sacral prosthesis reconstruction and the integrated total sacral prosthesis reconstruction was not statistically significant ( P=0.145). The stress on the iliac bone contact surface of the integrated total sacral prosthesis was 34.2° and manifested as shear force; the stress on the iliac bone contact surface of the modular total sacral prosthesis was 88.9° and manifested as compressive stress. Conclusions:This modular total sacral prosthesis exhibits lower peak stress compared with the integrated total sacral prosthesis and screw-rod system. The spinal stability of the modular total sacral prosthesis is comparable to that of the integrated total sacral prosthesis and superior to that of the screw-rod system.

Objective:To understand the epidemiological characteristics and spatial distribution of hemorrhagic fever with renal syndrome (HFRS) in Henan Province, and to provide a basis for the development of prevention and control measures.Methods:Data of reported cases with HFRS in Henan Province from January 2012 to December 2022 were obtained from the Chinese disease control and prevention information system subsystem infectious disease monitoring system. Descriptive epidemiological methods were used to analyze the temporal, regional, population distributions, and the type of clinical diagnoses of HFRS. The spatial clustering analyses were carried out at county level. Correlation analysis between different clinical diagnostic types and mortality rate was conducted using Pearson method.Results:A total of 2 843 HFRS cases were reported, with an average annual incidence rate of 0.26/100 000, and 49 cases died with a case-fatality rate of 1.72%. There were two peaks of incidence each year, which were fall and winter (from October to the next January) and late spring and summer peak (from May to July). Among the patients, 2 174(76.47%) were male and 2 294(80.69%) were farmers. The average ages of reported cases from 2012 to 2022 were 43.70 years, 45.44 years, 45.91 years, 48.33 years, 45.41 years, 48.53 years, 48.93 years, 48.87 years, 45.90 years, 51.27 years, and 50.89 years, respectively. There was a strong negative correlation between laboratory-confirmed cases and case fatality ( r=-0.652, P<0.001) , and a strong positive correlation between suspected cases, clinical-diagnosed cases and case fatality ( r=0.304, P=0.035 and r=0.623, P<0.001, respectively). A higher rate of case-fatality was found in areas with a lower number of reported cases. Case-fatality rate ranking among the top five counties were Weidong District (five cases of disease with two deaths), Muye District (three cases of disease with one death), Xinhua District (three cases of disease with one death), Shunhe Hui District (six cases of disease with one death), and Anyang County (53 cases of disease with six (11.32%) death). Global spatial autocorrelation analysis from 2012 to 2022 showed that the Moran′s I coefficients ranged from 0.138 to 0.326, and all of them had a correlation (all P<0.01). The high-high aggregation area was mainly concentrated in the confluence of Zhumadian City and Xinyang City in the south of Henan Province. Conclusions:In Henan Province, the reported cases of HFRS have been distributed throughout the province, with obvious spatio-temporal aggregation in some areas. The average age of reported cases shows a fluctuating upward trend. The rate of laboratory-confirmed diagnosis should be further improved in the high incidence areas.

ObjectiveThe antitumor activity of sesquiterpenoid M36 isolated from Myrrha against human hepatoma HepG2 cells was investigated in this study. MethodHepG2 cells were treated with M36 at different concentrations （0， 2， 4， 6， 8， 10 μmol·L^-1）. Firstly， the effects of M36 on the proliferation of human hepatoma HepG2 cells were detected by methyl thiazolyl tetrazolium （MTT）， colony formation assay， and EdU proliferation assay. Hoechst staining， flow cytometry analysis， and Western blot were used to explore the effect of M36 on the apoptosis of human hepatoma HepG2 cells. Acridine orange staining and western blotting were used to examine the effect of M36 on autophagy in HepG2 cells. Finally， Western blot was used to detect protein expression of cancer-related signaling pathways. ResultCompared with the blank group， M36 treatment significantly inhibited the proliferation of human hepatoma HepG2 cells （P<0.01）， and the half inhibitory concentration （IC₅₀） value of M36 for 48 h was 5.03 μmol·L^-1， in a dose- and time-dependent manner. M36 was also able to induce apoptosis and autophagy in human hepatoma HepG2 cells. After treatment with 8 μmol·L^-1 M36 for 48 hours， the apoptosis rate of HepG2 cells was （42.03±9.65）% （P<0.01）. Compared with the blank group， HepG2 cells treated with 4 and 8 μmol·L^-1 M36 for 48 h had a significant increase in cleaved poly ADP-ribose polymerase （cleaved-PARP） protein levels （P<0.01）. Acridine orange staining showed that autophagy was significantly activated in HepG2 cells treated with 4 and 8 μmol·L^-1 M36 for 48 h compared with the blank group （P<0.01）， which was further verified by the up-regulation of microtubule-associated protein 1 light chain 3 Ⅱ （LC3 Ⅱ）. Western blot results showed that compared with the blank group， the levels of phosphorylated extracellular regulated protein kinase （p-ERK）， phosphorylated p38 mitogen-activated protein kinase （p-p38 MAPK）， phosphorylated c-Jun N-terminal kinase （p-JNK）， and its downstream nuclear transcription factors c-Jun and p-c-Jun protein were significantly increased in M36 group （P<0.05， P<0.01）. The mechanism may be related to the up-regulation of MAPK signaling pathway. ConclusionThe sesquiterpenoid M36 isolated from Myrrha inhibits the proliferation of human hepatoma HepG2 cells and promotes apoptosis and autophagy， which may be related to the activation of the MAPK signaling pathway.

Objective:To investigate the distribution and hantavirus (HV) carrying state in host animals of hemorrhagic fever with renal syndrome (HFRS) in Henan Province from 2019 to 2022.Methods:Host animal monitoring was carried out at the monitoring sites of HFRS in Henan Province. The real-time fluorescence quantitative PCR was used to detect hantavirus in rat lungs. The types of hantavirus were analyzed. The positive samples were sequenced and then sequence homology and variation were analyzed.Results:A total of 1 308 rodents were captured from 2019 to 2022, 16 specimens of rat lungs tested positive for hantavirus nucleic acid. The positive rate of HV was 1.22% (16/1 308). According to type, the positive rate of HV in Apodius agrarius was the highest (68.75%, 11/16). According to distribution, the positive rate of HV in field samples was the highest (2.50%, 12/480), and the positive rate of HV in residential samples was 0.53% (4/759). The typing results of 16 positive samples showed that all viruses were hantavirus type Ⅰ (hantaan virus). The positive samples were sequenced and eight S gene fragments (GenBank number: OQ681444-OQ681451) and six M gene fragments (OQ681438-OQ681443) were obtained. The S and M gene fragments were similar to the Shaanxi 84FLi strain and Sichuan SN7 strain. Phylogenetic analysis of S and M gene fragments showed that they all belonged to the hantaan virus-H5 subtype. Amino acid sequence analysis revealed that, compared with the hantaan virus vaccine strain 84FLi, the 74th amino acid encoded by eight S fragments was replaced by aspartamide with serine. Tryptophan was replaced by glycine at the 14th position of Gn region in XC2022047, and isoleucine was replaced by alanine at the 359 position of XC2022022 and XC2022024.Conclusion:The hantavirus carried by host animals in Henan Province from 2019 to 2022 belongs to the type Ⅰ (hantaan virus), and Apodemus agrarius is still the dominant host animal of the hantaan virus. Compared with the vaccine strains, amino acid sites are replaced in the immune epitopes of the S and M gene fragments.

Objective:To explore the differences in bacterial community structure between proximal colon cancer (PC), distal colon cancer (DC), and rectal cancer (RC), and the values of featured microbiota in differentiating PC with tumor markers.Methods:This case-control study enrolled 85 newly diagnosed colorectal cancer patients, including 22 PC, 15 DC and 48 RC patients, and 8 colorectal adenoma patients from May 2019 to July 2022 at the Department of General Surgery, Anyang Oncology Hospital. The blood and fecal samples were collected before surgery and then subjected to biochemical tests for tumor markers and 16S rDNA tests, respectively. SPSS (27.0.1) was applied to perform the t-test, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, and Chi-Squared Test. Also, the receiver operating characteristic curve (ROC) was plotted on tumor markers and/or f_Bacteroidaceae with SPSS software .Results:All groups had significant differences in the CA125 ( F=3.543, P<0.05), CA72-4 ( F=3.596, P<0.05), and serum tumor-associated materials (TAM) levels ( F=5.787, P<0.01). In PC group, the levels of CA125 [PC vs RC, (36.84±6.30) kU/L vs (12.73±4.21) kU/L, P<0.01] and CA72-4 [PC vs RC, (45.56±10.86) kU/L vs (3.30±7.63) kU/L, P<0.01] were significantly higher than that of the RC group, while the level of TAM was remarkably elevated in PC group than in RC group [PC vs RC, (124.84±5.19) U/ml vs (102.44±3.63) U/ml, P<0.001] and CRA group [PC vs CRA, (124.84±5.19) U/ml vs (95.39±8.42) U/ml, P<0.01]. The LEfSe analysis showed that the featured microbiota in the PC group included f_Bacteroidaceae, f_Neisseriaceae, f_Clostridiaceae_1, f_Spirochaetaceae, and so on. The largest area under the ROC belonged to the combination of TAM and f_Bacteroidaceae, which reached 0.845 (95% CI 0.747-0.944), with sensitivity being 0.857 and specificity being 0.815. Conclusions:There is heterogeneity in gut microbiota composition among PC, DC, RC, and CRA. The combination of gut microbiota and tumor biomarkers demonstrated good differentiating effects in proximal colon cancers.

Objective:To understand the epidemiological characteristics and spatial distribution of hemorrhagic fever with renal syndrome (HFRS) in Henan Province, and to provide a basis for the development of prevention and control measures.Methods:Data of reported cases with HFRS in Henan Province from January 2012 to December 2022 were obtained from the Chinese disease control and prevention information system subsystem infectious disease monitoring system. Descriptive epidemiological methods were used to analyze the temporal, regional, population distributions, and the type of clinical diagnoses of HFRS. The spatial clustering analyses were carried out at county level. Correlation analysis between different clinical diagnostic types and mortality rate was conducted using Pearson method.Results:A total of 2 843 HFRS cases were reported, with an average annual incidence rate of 0.26/100 000, and 49 cases died with a case-fatality rate of 1.72%. There were two peaks of incidence each year, which were fall and winter (from October to the next January) and late spring and summer peak (from May to July). Among the patients, 2 174(76.47%) were male and 2 294(80.69%) were farmers. The average ages of reported cases from 2012 to 2022 were 43.70 years, 45.44 years, 45.91 years, 48.33 years, 45.41 years, 48.53 years, 48.93 years, 48.87 years, 45.90 years, 51.27 years, and 50.89 years, respectively. There was a strong negative correlation between laboratory-confirmed cases and case fatality ( r=-0.652, P<0.001) , and a strong positive correlation between suspected cases, clinical-diagnosed cases and case fatality ( r=0.304, P=0.035 and r=0.623, P<0.001, respectively). A higher rate of case-fatality was found in areas with a lower number of reported cases. Case-fatality rate ranking among the top five counties were Weidong District (five cases of disease with two deaths), Muye District (three cases of disease with one death), Xinhua District (three cases of disease with one death), Shunhe Hui District (six cases of disease with one death), and Anyang County (53 cases of disease with six (11.32%) death). Global spatial autocorrelation analysis from 2012 to 2022 showed that the Moran′s I coefficients ranged from 0.138 to 0.326, and all of them had a correlation (all P<0.01). The high-high aggregation area was mainly concentrated in the confluence of Zhumadian City and Xinyang City in the south of Henan Province. Conclusions:In Henan Province, the reported cases of HFRS have been distributed throughout the province, with obvious spatio-temporal aggregation in some areas. The average age of reported cases shows a fluctuating upward trend. The rate of laboratory-confirmed diagnosis should be further improved in the high incidence areas.