BACKGROUND:With the development of the aging trend of society,the incidence of femoral neck fractures is increasing.Currently,the preferred surgical treatment is cannulated screw internal fixation.However,post-surgical femoral neck shortening occurs in some cases,resulting in impaired hip functionality.OBJECTIVE:To investigate the incidence of femoral neck shortening following the use of half-threaded cannulated screws for internal fixation in patients with femoral neck fractures,to analyze the effect on hip function,and to identify factors contributing to neck shortening.METHODS:A retrospective analysis was conducted on the medical records of 102 patients treated with half-threaded cannulated screws in an inverted triangle setup for femoral neck fractures at Affiliated Hai'an Hospital of Nantong University from January 2016 to January 2021.This group included 36 males and 66 females at the mean age of(57.2±7.7)years,with 34 cases of Garden type Ⅰ and Ⅱ fractures and 68 of Garden type Ⅲ and Ⅳ fractures.The mean bone mineral density value T was-2.8 SD.The Harris score was used to evaluate the hip function.During the follow-up period,the occurrence of femoral neck shortening was determined using X-ray imagery,and the factors influencing this shortening were examined using both univariate and multivariate regression analyses.RESULTS AND CONCLUSION:(1)Among the 102 patients with femoral neck fractures,30 patients developed femoral neck shortening,accounting for 29.4％.72 patients had no femoral neck shortening(70.6％).(2)The Harris score for patients experiencing neck shortening was significantly lower than that for patients without shortening(P＜0.05).(3)The study identified several factors associated with femoral neck shortening following the internal fixation of femoral neck fractures included age,gender,bone mineral density value T,preoperative Garden classification,and quality of reduction.These factors not only affect the shortening of the femoral neck after surgery,but are also directly related to the functional performance of the patient's hip joint.(4)Femoral neck shortening after surgery for femoral neck fracture is associated with various clinical parameters,especially the patient's age,gender,bone mineral density,preoperative classification,and accuracy of reduction during surgery.

BACKGROUND:With the development of the aging trend of society,the incidence of femoral neck fractures is increasing.Currently,the preferred surgical treatment is cannulated screw internal fixation.However,post-surgical femoral neck shortening occurs in some cases,resulting in impaired hip functionality.OBJECTIVE:To investigate the incidence of femoral neck shortening following the use of half-threaded cannulated screws for internal fixation in patients with femoral neck fractures,to analyze the effect on hip function,and to identify factors contributing to neck shortening.METHODS:A retrospective analysis was conducted on the medical records of 102 patients treated with half-threaded cannulated screws in an inverted triangle setup for femoral neck fractures at Affiliated Hai'an Hospital of Nantong University from January 2016 to January 2021.This group included 36 males and 66 females at the mean age of(57.2±7.7)years,with 34 cases of Garden type Ⅰ and Ⅱ fractures and 68 of Garden type Ⅲ and Ⅳ fractures.The mean bone mineral density value T was-2.8 SD.The Harris score was used to evaluate the hip function.During the follow-up period,the occurrence of femoral neck shortening was determined using X-ray imagery,and the factors influencing this shortening were examined using both univariate and multivariate regression analyses.RESULTS AND CONCLUSION:(1)Among the 102 patients with femoral neck fractures,30 patients developed femoral neck shortening,accounting for 29.4％.72 patients had no femoral neck shortening(70.6％).(2)The Harris score for patients experiencing neck shortening was significantly lower than that for patients without shortening(P＜0.05).(3)The study identified several factors associated with femoral neck shortening following the internal fixation of femoral neck fractures included age,gender,bone mineral density value T,preoperative Garden classification,and quality of reduction.These factors not only affect the shortening of the femoral neck after surgery,but are also directly related to the functional performance of the patient's hip joint.(4)Femoral neck shortening after surgery for femoral neck fracture is associated with various clinical parameters,especially the patient's age,gender,bone mineral density,preoperative classification,and accuracy of reduction during surgery.

Background Other infectious diarrhea (OID) refers to infectious diarrhea other than cholera, dysentery, and typhoid/paratyphoid fever. In the global climate change context, frequent extreme temperature events pose a significant threat to population health, yet the association between extreme temperatures and OID remains unclear. Objective To understand the impact of extreme temperature events on the incidence of OID in Taizhou region, and provide a scientific basis for formulating targeted public health intervention strategies. Methods Case data of OID from 2016 to 2024 and meteorological and pollutant data of Taizhou, Zhejiang during the same period were collected. The case data were derived from National Notifiable Infectious Diseases Reporting System, while the meteorological data and pollutant data were obtained from National Meteorological Science Data Center and Taizhou Ecology and Environment Bureau, respectively. An extreme heat event is defined as a period of two or more consecutive days in the warm season during which the daily mean temperature exceeds the 90th percentile value for that season. Similarly, an extreme cold event is defined as a period of two or more consecutive days in the cold season during which the daily mean temperature falls below the 10th percentile value. A distributed lag nonlinear model based on Poisson regression was used to assess the impact of extreme temperatures on OID incidence. Furthermore, subgroup analyses were conducted by gender and age. Results From 2016 to 2024, a total of 108 670 OID cases were reported in Taizhou, with higher incidence in males (61 253 cases) than females (47 417 cases). In terms of single-day lag effect, exposure to extreme cold presented an inverted U-shaped risk pattern: a significant risk effect began to emerge on the 4th day after exposure, continued to rise, and reached a peak on the 7th day (RR=1.044, 95%CI: 1.029, 1.058), whereas extreme heat had no significant impact. In terms of cumulative lag effect, exposure to extreme cold presented a J-shaped cumulative effect curve: short-term exposure (0-2 days) showed no risk effect, but as time extended (0-9 days), a risk effect emerged and reached the maximum risk value during the 0-12 d cumulative period (RR=1.243, 95%CI: 1.057, 1.461). In contrast, extreme heat had no cumulative lag effect. The subgroup analysis revealed that under extreme cold exposure, the single-day lag effects for both males and females exhibited an inverted U-shaped curve, with the risk peaking on day 7 for males (RR=1.045, 95%CI: 1.026, 1.065) and day 8 for females (RR=1.041, 95%CI: 1.019, 1.064). The risk pattern in the 1-5 years age group was similar to that of the overall population but with a higher effect size (RR=1.063, 95%CI: 1.041, 1.085). In terms of the cumulative lag effects, the cumulative risk curves for both males and females under extreme cold exposure showed a J-shaped pattern with varied risk profiles. Significant variations in risk patterns were observed across different age groups. No significant cumulative lag effects were observed for extreme heat exposure in any subgroup. Conclusion Extreme cold can increase the incidence of OID in Taizhou, and the risk effects are heterogeneous among different groups. No risk effect is observed for extreme heat.

Objective To explore the perioperative safety and prognostic factors of sequential hepatectomy after conversion therapy using vascular interventional therapy(including transarterial chemoembolization and hepatic arterial infusion chemotherapy)combined with tyrosine kinase inhibitors(TKI)and programmed death-1(PD-1)inhibitors in patients with initially unresectable hepatocellular carcinoma.Methods The clinical data of 106 eligible HCC patients treated in Tumor Hospital Affiliated to Guangxi Medical University from Nov.2019 to Apr.2024 were retrospectively analyzed.The perioperative parameters and postoperative pathological outcomes were described in detail,and factors influencing prognosis were analyzed.Results The median operative time for hepatectomy after conversion therapy was 240 min,with a median blood loss of 200 mL.Intraoperative blood transfusion was required in 24(22.6％)patients.Postoperative adverse reactions occurred in 49.1％(52/106)of patients,with liver failure being the most common adverse reactions(23 patients,21.7％).One(0.9％)patient died during the perioperative period,while the remaining 105 patients were followed up for a median duration of 14.7 months,during which 49(46.2％)patients experienced recurrence.Among them,39(36.8％)cases experienced early recurrence(within 1 year),and 33(31.1％)cases had intrahepatic recurrence.Thirteen(12.3％)patients died during follow-up.The median recurrence-free survival(RFS)was 15.7 months,with 1-year and 2-year RFS rates being 56.9％and 40.3％,respectively.The median overall survival(OS)was not reached,with 1-year and 2-year OS rates being 94.2％and 85.3％,respectively.Multivariate Cox regression analysis demonstrated that achieving complete pathological response(hazard ratio[HR]=0.410,95％confidence interval[CI]0.172-0.980,P=0.045),presence of microvascular invasion(HR=2.423,95％CI 1.269-4.625,P=0.007),satellite nodules(HR=1.916,95％CI 1.014-3.620,P=0.045),and multiple tumors(HR=1.818,95％CI 1.012-3.241,P=0.046)were independent factors associated with postoperative recurrence.Conclusion For patients with initially unresectable hepatocellular carcinoma,vascular interventional therapy combined with TKI and PD-1 inhibitors followed by sequential hepatectomy may be a feasible treatment strategy,with manageable adverse reactions and promising efficacy.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Objective:To explore the effects of respiratory muscle training(RMT)combined with phrenic nerve electrical stimulation(PNES)on coughing ability and lung function in stroke patients with pulmonary infection.Method:A total of 66 patients with pulmonary infection after stroke,admitted to our hospital from January 2022 to January 2024,were randomly assigned to either an observation group or a control group,with 33 cas-es in each group.During the study,three patients from each group dropped out.Both groups received conven-tional pharmacological and rehabilitation treatment.Additionally,the observation group received combined RMT and PNES,administered once a day,5 days per week,for 4 weeks.Outcome measures included:Cough peak flow rate(CPF),Clinical Pulmonary Infection Score(CPIS),and Borg Dyspnea Scale scores,assessed at baseline,1 week,2 weeks,and 4 weeks.Pulmonary function tests were performed at baseline and after 4 weeks,including maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),forced vital ca-pacity(FVC),forced expiratory volume in the first second(FEV1),maximum volume per minute(MVV).The percentages of predicted values(FVC％,FEV1％,MVV％)were calculated.Coughing ability and pulmo-nary function were compared between the groups.Result:At baseline and after 1 week of treatment,there were no significant between-group differences in CPF,CPIS,or Borg Dyspnea scores(P>0.05).However,after 2 and 4 weeks of treatment,the observation group showed significantly greater improvements in CPF,CPIS,and Borg Dyspnea scores compared to the control group(P<0.05).Furthermore,after 4 weeks of treatment,the improvement in all pulmonary function parame-ters(MIP,MEP,FVC％,FEV1％,MVV％)was significantly greater in the observation group than in the con-trol group(P<0.05).Conclusion:Respiratory muscle training combined with phrenic nerve electrical stimulation can effectively improve the coughing ability,alleviate pulmonary infection,and enhance lung function in stroke patients within a short peri-od of time,which is worthy of promotion and application in the treatment of lung infection in early stroke.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Objective:To explore the effects of respiratory muscle training(RMT)combined with phrenic nerve electrical stimulation(PNES)on coughing ability and lung function in stroke patients with pulmonary infection.Method:A total of 66 patients with pulmonary infection after stroke,admitted to our hospital from January 2022 to January 2024,were randomly assigned to either an observation group or a control group,with 33 cas-es in each group.During the study,three patients from each group dropped out.Both groups received conven-tional pharmacological and rehabilitation treatment.Additionally,the observation group received combined RMT and PNES,administered once a day,5 days per week,for 4 weeks.Outcome measures included:Cough peak flow rate(CPF),Clinical Pulmonary Infection Score(CPIS),and Borg Dyspnea Scale scores,assessed at baseline,1 week,2 weeks,and 4 weeks.Pulmonary function tests were performed at baseline and after 4 weeks,including maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),forced vital ca-pacity(FVC),forced expiratory volume in the first second(FEV1),maximum volume per minute(MVV).The percentages of predicted values(FVC％,FEV1％,MVV％)were calculated.Coughing ability and pulmo-nary function were compared between the groups.Result:At baseline and after 1 week of treatment,there were no significant between-group differences in CPF,CPIS,or Borg Dyspnea scores(P>0.05).However,after 2 and 4 weeks of treatment,the observation group showed significantly greater improvements in CPF,CPIS,and Borg Dyspnea scores compared to the control group(P<0.05).Furthermore,after 4 weeks of treatment,the improvement in all pulmonary function parame-ters(MIP,MEP,FVC％,FEV1％,MVV％)was significantly greater in the observation group than in the con-trol group(P<0.05).Conclusion:Respiratory muscle training combined with phrenic nerve electrical stimulation can effectively improve the coughing ability,alleviate pulmonary infection,and enhance lung function in stroke patients within a short peri-od of time,which is worthy of promotion and application in the treatment of lung infection in early stroke.