PURPOSE: Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals. METHODS: A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test. RESULTS: The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67% in the TXA group and 47.95% in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups. CONCLUSION We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
Humans ; Tranexamic Acid/administration & dosage* ; Hip Fractures/surgery* ; Male ; Aged ; Female ; Fracture Fixation, Intramedullary/adverse effects* ; Blood Loss, Surgical/prevention & control* ; Antifibrinolytic Agents/administration & dosage* ; Aged, 80 and over ; Bone Nails ; Middle Aged ; Blood Transfusion/statistics & numerical data*

As a novel form of cell death, ferroptosis is mainly regulated by the accumulation of soluble iron ions in the cytoplasm and the production of lipid peroxides and is closely associated with several diseases, including acute kidney injury, ischemic reperfusion injury, neurodegenerative diseases, and cancer. The term "immunosuppression" refers to various factors that can directly harm immune cells' structure and function and affect the synthesis, release, and biological activity of immune molecules, leading to the insufficient response of the immune system to antigen production, failure to successfully resist the invasion of foreign pathogens, and even organ damage and metabolic disorders. An immunosuppressive phase commonly occurs in the progression of many ferroptosis-related diseases, and ferroptosis can directly inhibit immune cell function. However, the relationship between ferroptosis and immunosuppression has not yet been published due to their complicated interactions in various diseases. Therefore, this review deeply discusses the contribution of ferroptosis to immunosuppression in specific cases. In addition to offering new therapeutic targets for ferroptosis-related diseases, the findings will help clarify the issues on how ferroptosis contributes to immunosuppression.
Ferroptosis/immunology* ; Humans ; Immune Tolerance/immunology* ; Animals ; Immunosuppression Therapy ; Iron/metabolism* ; Neoplasms/immunology*

Objective To explore the diagnostic value of serum C-C motif chemokine ligand 3(CCL3)and Semaphorin 3A in patients with type 2 diabetes mellitus(T2DM)complicated by osteoporosis(OP).Methods A total of 125 patients with T2DM complicated by OP who visited the hospital from August 2022 to August 2023 were selected as the OP group,and another 125 patients with T2DM without OP who visited the hospital during the same period were selected as the T2DM group.The OP group was divided into Group A(T value>-1.0,but slightly lower than the normal value),Group B(T value between-2.5 and-1.0),and Group C(T value<-2.5)based on the measurement results of bone mineral density(BMD).The lev-els of serum CCL3 and Semaphorin 3A in each group were compared.Pearson correlation analysis was used to analyze the correlations between serum CCL3,Semaphorin 3A and BMD in patients with T2DM complicated by OP.Multivariate Logistic regression analysis was used to analyze the influencing factors of T2DM compli-cated by OP.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of se-rum CCL3 and Semaphorin 3A for T2DM complicated by OP.Results Compared with the T2DM group,the serum CCL3 level in the OP group increased,and the Semaphorin 3A level decreased,and the difference was statistically significant(P<0.05).Compared with group A,the serum CCL3 levels in group B and group C increased,while the Semaphorin 3A level decreased,and the differences were statistically significant(P<0.05).Compared with group B,the serum CCL3 level in group C increased and the Semaphorin 3A level de-creased,and the difference was statistically significant(P<0.05).Compared with the T2DM group,the femo-ral neck bone BMD,lumbar spine BMD and total hip BMD in the OP group were significantly decreased,and the difference was statistically significant(P<0.05).The serum CCL3 level in patients with T2DM accompa-nied by OP was negatively correlated with femoral neck bone BMD,lumbar spine BMD and total hip BMD(P<0.05),and the serum Semaphorin 3A level was positively correlated with femoral neck bone BMD,lum-bar spine BMD and total hip BMD(P<0.05).The results of multivariate Logistic regression analysis showed that CCL3 was an independent risk factor for T2DM with OP(P<0.05),and Semaphorin 3A was an inde-pendent protective factor for T2DM with OP(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of serum CCL3,Semaphorin 3A and their combination diagnosis of T2DM accom-panied by OP were 0.810,0.802 and 0.869,respectively.The AUC of the combined diagnosis of T2DM ac-companied by OP was superior to their individual diagnoses(Zcombination-CCL3=2.235,Zcombination-Semaphorin 3A=2.021,P=0.025,0.043).Conclusion The serum CCL3 level is increased in patients with T2DM accompanied by OP,and the Semaphorin 3A level is decreased.The combination of the two has certain diagnostic value for T2DM accompanied by OP.

Objective To analyze the effect of Physio Space balance board motor control training on rehabilitation of ankle joint injuries in a prospective randomized controlled study.Methods A total of 96 patients with ankle joint injuries treated at Yunnan Provincial Hospital of Traditional Chinese Medicine from May 2022 to May 2023 were selected and randomly divided into the study group(n=48)and the control group(n=48).Both groups received conventional physical therapy.The control group underwent standard rehabilitation training,while the study group added Physio Space balance board exercise control training on top of the control group's regimen.The therapeutic effect,ankle stability[Cumberland Ankle Instability Tool(CAIT)score],ankle joint range of motion(dorsoextension,plantar flexion),pain levels,balance ability of the affected limb[mean displacement on the X-axis(Mcd)and mean displacement on the Y-axis(Msd)scores],and serum inflammatory pain factor levels[Substance P(SP),Tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),Neuropeptide(NPY)]were compared between the two groups.Results The rate of excellent and good treatment in the study group(93.75%vs.79.17%)was higher than that in the control group(P<0.05).After 1,2,3 and 4 weeks of treatment,the CAIT score of the study group was higher than that of the control group,and the VAS score was lower than that of the control group(P<0.05).After 2 and 4 weeks of treatment,the dorsiflexion and plantarflexion range of motion in the study group were higher than those in the control group(P<0.05).The Mcd and Msd scores in the study group were lower than those in the control group after 2 and 4 weeks of treatment(P<0.05).After 2 and 4 weeks of treatment,the serum levels of TNF-α,IL-6,SP and NPY in the study group were lower than those in the control group(P<0.05).Conclusion Physio Space balance board motion control training shows significant efficacy in the rehabilitation treatment of ankle joint injuries and is worthy of promotion and application.

Knee osteoarthritis(KOA)is a common chronic degenerative bone and joint disease characterized by degeneration and wear of knee cartilage.It is commonly found in middle-aged and elderly people and seriously impacts on their lower limb activity and quality of life.At present,the treatment of early and middle stage KOA mainly relies on the conservative methods such as oral medication,joint injection,topical patches and traditional Chinese medicine.Platelet rich plasma(PRP),as an autologous platelet concentrate,is rich in various growth factors and has no risk of immune rejection.In recent years,it has been widely used in the repair of bone,joint,and soft tissue injuries.However,the short biological half-life of growth factors in PRP and the fluidity of injection sites can result in insufficient binding force,short action time,poor target therapy efficacy,and the need for repeated injections in the joint cavity,which will increase the risk of iatrogenic infections.Hydrogels are cross-linked polymer networks containing water,and their high histocompatibility and drug release have attracted much attention.The slow and continuous release of drug is achieved by loading PRP onto hydrogel.Its unique adhesion reduces the flow of drug in the joint,thus extending the local action time of PRP and reducing the need for repeated injection.This article reviews the biological characteristics of PRP and hydrogel,the mechanism of action and clinical application of PRP loaded hydrogel in the treatment of KOA,and analyzes the existing problems and challenges,aiming to provide more effective treatment options for KOA patients through the in-depth discussion of this new treatment method.

Objective To analyze the application of in-use laparoscopes in clincal departments to enhance the laparoscope's effectiveness.Methods The effective utilization data of 29 laparoscopes from January 2024 to June 2024 were acquired with an hospital intelligent medical device management platform.Comparisons were carried out in terms of average daily workload,average daily hours of use and average daily efficiency between the laparoscopes from different departments and brands with non-parametric Kruskal-Wallis test and between the conventional and 3D laparoscopes with non-parametric Mann-Whitney U test.Pearson's correlation coefficient was used to analyze the correlation between the number of years of laparoscope use and the average daily workload,the average daily hours of use,and the average daily efficiency and the chi-square test was applied to investigating the relationship between the surgery grade and the type of equipment selected.Results Thoracic sugery department had the highest average daily workload(3.82 person-time),while the general medical department had the highest average daily hours of use(443.76 min)and the highest daily efficiency(92.45％).There were significant differences between the laparoscopes from different departments in average daily workload,average daily hours of use and average daily efficiency(P＜0.05).Brand D laparoscope behaved the best among brands of laparoscopes with the highest average daily workload(3.72 person-time),average daily hours of use(394.41 min)and average daily efficiency(82.17％).There were sig-nificant differences between the brands of laparoscopesin average daily workload,average daily hours of use and average daily efficiency(P＜0.05).3D laparoscopes obviously gained advantages over the conventional ones in average daily workload,average daily hours of use and average daily efficiency(P＜0.05).The number of years of use correlated negatively with average daily workload,average daily hours of use and average daily efficiency,with Pearson correlation coefficients being-0.095,-0.039 and-0.039 respectively.Grade Three and Four surgeries had significant differences in types of selected equipment(P＜0.001),and 3D laparoscopes were preferred for Grade Four surgery.Conclusion Utilization analysis of laparoscopes provides data support for optimized application and setup of laparoscopes.[Chinese Medical Equipment Journal,2025,46(2):87-91]

Objective To carry out quality control testing of anesthesia ventilators to ensure the reliability and safety during their clinical use.Methods Totally 88 anesthesia ventilators used in some hospital underwent quality control testing in terms of tidal volume,peak airway pressure and positive end-expiratory pressure by using a gas flow analyzer according to JJF(E)61-2020 Calibration Specification of Anesthetic Machines,which included 31 ones,36 ones,12 ones and 9 ones respectively from brand A,B,C and D.The Kruskal-Wallis test was used to analyze the variability of the measured values and errors of the performance indicators between different brands of anesthesia ventilators,the chi-square test was applied to discussing the variability of the accuracy class of the performance indicators between different brands of anesthesia ventilators,and the Pearson correlation coefficient was adopted to investigate the correlation between the years of use and the absolute values of the relative errors of the performance indicators.Results The 88 anesthesia ventilators had the overall pass rate for quality control testing being 42.05%,of which,brand B had the highest pass rate(52.78%)and brand C had the lowest pass rate(8.33%).Brand B gained advantages in tidal volume when compared with brand A,C and D,with the differences being significant(P<0.05);brand A behaved the best in peak airway pressure and positive end-expiratory pressure when compared with brand B,C and D,with the differences being significant(P<0.05).Brand A had the highest proportion(63.08%)of distinction and credit in terms of the three performance indicators.The absolute value of the relative error in tidal volume was positively correlated with the years of use at the 3 measurement points for setting values of 400,600,and 800 mL respectively(P<0.05),and there was a significant correlation between the absolute value of the relative error and the years of use at a peak airway pressure setting of 10 cmH2O(1 cmH2O=98.07 Pa)(P<0.05).Conclusion Quality control testing of anesthesia ventilators contributes to finding the risks during their application,which can be an effective tool to ensure the safety of anesthesia ventilators used in medical institutions.[Chinese Medical Equipment Journal,2025,46(9):75-80]

Objective To analyze cases of Langerhans cell histiocytosis(LCH)initially presenting with hemophagocytic lymphohistiocytosis(HLH)in order to enhance clinicians'awareness and avoid misdiagnosis or missed diagnosis.Methods Clinical characteristics of two cases of LCH with HLH as the initial symptom cases were retrospectively collected and analyzed.Results Both patients were male and admitted with"fever and bicytopenia".The physical examination revealed scattered rashes and hepatosplenomegaly.Based on the laboratory results,HLH was initially considered in both children.In case 1,the underlying disease was not immediately identified,but a skin biopsy later confirmed LCH.The patient's symptoms improved with LCH-directed therapy;however,a secondary pulmonary infection triggered progressive hemophagocytosis,which was successfully controlled after adding HLH treatment.In Case 2,HLH treatment initially stabilized the fever.After a skin biopsy confirmed LCH,combined LCH therapy was administered,and the symptoms improved.Both patients received regular chemotherapy according to the CCHG-LCH-2019 protocol.During follow-up,Case 1 developed a BRAF gene mutation and was treated with oral trametinib in addition to chemotherapy.As of the latest follow-up,both patients remained in stable condition.Conclusion Children with HLH and accompanied by a rash should actively search for the underlying cause.A skin biopsy should be performed promptly to clarify the diagnosis.Once the diagnosis is confirmed,active treatment is necessary,a single treatment approach should be avoided,and timely assessment of the condition should be conducted to achieve personalized treatment.

Objective To investigate the neurovascular coupling(NVC)status in the acute phase of patients with minor ischemic stroke(MIS)or transient ischemic attack(TIA)due to intracranial large artery moderate-to-severe stenosis or occlusion using multimodal MRI techniques and to explore its correlation with quality of life(QoL).Methods This prospective,consecutive study enrolled patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion form the Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,between June 2022 and October 2023.Recruit healthy subjects with matched age,sex,and handedness form the community during the same period.Patients were divided into left-sided involvement and right-sided involvement groups based on the affected side of the responsible vessel,while the healthy subjects were set as the healthy control group.Post-hoc power analysis was performed using G*Power 3.1 software.General characteristics(age,gender,body mass index,education level)were collected and compared across all three groups.Clinical data and QoL assessment were collected and compared between the two patient groups.Collected clinical data including type of cerebrovascular events(TIA,MIS),the National Institutes of Health stroke scale(NIHSS)score at admission,the responsible vessel(internal carotid artery,middle cerebral artery)and its side location,the degree of responsibility artery stenosis(moderate-severe stenosis[50%-99%stenosis rate],occlusion[100%stenosis rate]),the intracranial collateral circulation status(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASITN/SIR]collateral circulation grading),cerebrovascular risk factors(hypertension,diabetes,hyperlipidemia,smoking history),and the laboratory test indicators at admission(glycated hemoglobin,triglycerides,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,blood uric acid,blood homocysteine).QoL was assessed using the stroke impact scale(SIS),covering eight functional domains and a patient-reported overall recovery item.Multimodal MR data were acquired for all subjects.Whole-brain cerebral blood flow(CBF)images were generated using statistics parameter mapping 12(SPM 12)software,while regional homogeneity(ReHo)images were generated using DPABI software.The voxel-wise ratio of CBF to ReHo(CBF/ReHo)was calculated as the regional NVC parameter.Differences in regional NVC characteristics were compared between patient groups and the healthy control group.Correlations between NVC parameters and SIS scores within patient groups were explored.Results(1)A total of 38 patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion were included(26 males,12 females,aged 36-69 years,with mean age of[52±11]years),with 23 in the left-sided involvement group and 15 in the right-sided involvement group.Nineteen healthy subjects were included(10 males,9 females,aged 37-67 years,with mean age of[53±10]years).Post-hoc power analysis showed statistical power of 0.808 for comparing the left-sided involvement group with the healthy control group and 0.762 for comparing the right-sided involvement group with control group.(2)No statistically significant differences were found on gender,age,education level,or body mass index across the three groups(all P＞0.05).No statistically significant differences were observed on the type of cerebrovascular event,cerebrovascular risk factors,distribution of the responsible vessel,degree of stenosis in the responsible vessel,admission NIHSS score,or laboratory test results between the two patient groups(all P＞0.05).There were no statistically significant differences in the total SIS score and the scores of subscales between the two patient groups(all P＞0.05).(3)Compared with the healthy control group,the left-sided involvement group exhibited reduced CBF/ReHo values in the left superior and middle temporal gyri,supramarginal gyrus,middle and inferior frontal gyri,precentral gyrus,angular gyrus,postcentral gyrus,insula,and posterior cerebellar lobe(FDR-corrected,all P＜0.05).In the right-sided involvement group,reduced CBF/ReHo values were observed in the right supramarginal gyrus,right postcentral gyrus,inferior temporal gyrus,and insula(FDR-corrected,all P＜0.05).(4)Correlation analysis revealed that the SIS total score in the left-sided involvement group negatively correlated with CBF/ReHo values in the right inferior frontal gyrus(T=-5.91)and the right middle temporal gyrus(T=-6.65,FDR-corrected,both P＜0.05).The SIS subscale score for activities of daily living in the left-sided involvement group showed negative correlations with CBF/ReHo values in the right angular gyrus(T=-7.36),right medial superior frontal gyrus(T=-6.97),right orbitofrontal cortex(T=-8.99),and left thalamus(T=-7.51,FDR-corrected,all P＜0.05).No significant correlation was observed between the SIS total score and CBF/ReHo values in patients with right-sided involvement group.The SIS subscale for communication score in the right-sided involvement group correlated with CBF/ReHo in the left lingual gyrus(T=-12.15),left olfactory cortex(T=-7.68),and right anterior cingulate and paracingulate cortex(T=-9.46,FDR-corrected,all P＜0.05).Conclusions Patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion show abnormal NVC in the acute phase,especially those with left hemisphere involvement,who exhibit more extensive impairments.QoL in left-sided involvement patients is strongly linked to NVC in the right orbitofrontal cortex and right middle temporal gyrus.These findings require further validation in larger-scale studies.

Objective This study aimed to investigate the correlation of cerebral perfusion and cognitive function status in patients with minor stroke(MS)or transient ischemic attack(TIA)complicated by severe intracranial arterial stenosis or occlusion(hereafter referred to as ICAS-MSTIA).Methods Retrospectively enrol consecutive ICAS-MSTIA patients admitted to the Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,from June 2023 to May 2024.In the meantime,healthy controls were openly recruited.The ICAS-MSTIA patients were divided into two groups based on the side of intracranial large artery stenosis or occlusion:the left intracranial large artery involvement group and the right intracranial large artery involvement group.All patients with intracranial large artery stenosis or occlusion underwent MR scanning within 2 weeks after the first episode of TIA or MS,while there was no specific time requirement for MR examination in the healthy control group.On the day of MR scanning,the Montreal cognitive assessment(MoCA)scale was used to evaluate the participants'global cognitive function and performance in various cognitive domains,including visuospatial/executive function,naming,attention,language,abstraction,delayed recall,and orientation.General information of all participants was collected,including age,sex,educational level,body mass index,and history of smoking and alcohol consumption.Clinical data were collected from both left and right intracranial large artery involvement groups,including cerebrovascular risk factors(such as,diabetes mellitus,hypertension,and hyperlipidemia),National Institutes of Health stroke scale(NIHSS)score at admission,responsible stenotic or occluded arteries(internal carotid artery,middle cerebral artery),degree of stenosis in the responsible vessel(severe stenosis[stenosis rate 70%-99%],occlusion[stenosis rate100%])and non-responsible vessel(no stenosis[0],mild stenosis[stenosis rate＞0-49%]),collateral circulation compensation(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASTIN/SIR]collateral circulation classification),and responsible events(TIA,MS).General data and MoCA scale scores were compared across the three groups,while clinical data were compared between the left and right intracranial large artery involvement groups.Statistical parametric mapping 12(SPM 12)was used to perform voxel-wise independent samples t-tests on cerebral blood flow(CBF)differences among the left ICAS-MSTIA group,right ICAS-MSTIA group,and healthy control group,with cluster-level family-wise error(FWE)correction applied for adjustment.Multiple linear regression analysis was conducted to evaluate the relationship between global CBF values and total MoCA scores in ICAS-MSTIA patients with left or right intracranial large artery involvement.Results A total of 33 ICAS-MSTIA patients and 33 healthy controls were enrolled in the study.Among the ICAS-MSTIA patients,21 had left intracranial large artery involvement and 12 had right involvement.(1)Among the three groups,statistically significant differences were observed in the proportions of individuals with reported smoking history(P=0.024)and alcohol consumption history(P=0.011).The left intracranial large artery involvement group had a higher NIHSS score(0[0,2]vs.0[0,0],P=0.044)and a higher proportion of patients with internal carotid artery involvement(13/21 cases vs.2/12 cases,P=0.027)compared with the right side group.No statistically significant differences were observed in other general or clinical data across the three groups or between the two non-control groups(all P＞0.05).(2)Statistically significant differences were found across the three groups in the MoCA scale total score and scores of visuospatial/executive function,attention,language,abstraction,delayed recall,and orientation cognitive domains(all P＜0.05),while no significant difference was noted in the naming score(P=0.063).The left intracranial large artery involvement group had lower total MoCA score and lower scores in visuospatial/executive function,attention,language,abstraction,delayed recall,and orientation in comparison to the healthy control group(all P＜0.016 7).The right intracranial large artery involvement group had significantly lower scores in language,abstraction,and orientation domains than the healthy control group(all P＜0.016 7).Additionally,the left side group had a lower attention domain score than the right side group(P＜0.016 7).No other statistically significant differences were found in pairwise comparisons(all P＞0.016 7).(3)Patients in both the left and right intracranial large artery involvement groups exhibited a significant decrease in CBF in extensive regions on the affected side,including the temporal lobe,dorsolateral prefrontal cortex,and occipital lobe.Furthermore,after correction,in the left involvement group CBF was higher in the contralateral lingual gyrus,cuneus,and calcarine sulcus compared with the healthy control group(P＜0.05).While in the right involvement group,no regions had increased CBF compared to the healthy control group.(4)Multiple linear regression showed positive correlation between CBF in ipsilateral precentral gyrus and superior temporal gyrus,and the total MoCA score in patients with left intracranial large artery involvement(FWE-corrected,P＜0.05).In contrast,there was no correlation between CBF and total MoCA score in patients with right intracranial large artery involvement.Conclusions ICAS-MSTIA patients exhibited various degrees of impairment in cerebral perfusion and cognitive function.A significant positive correlation is observed between these two impairments in patients with left intracranial large artery involvement.