Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Objective To construct the animal model,and to study the expression and clinical signifi-cance of YKL-40 in the progress of chronic renal failure complicating cardiac dysfunction.Methods C57BL/6N mice were chosen as the experimental subjects and divided into the blank control(BC)group,renal failure(RF)group,heart failure(HF)group and renal combined heart failure group.The renal failure model was constructed by adenine perfusion.The heart failure model was constructed by subcutaneous injection of isopro-terenol.The renal failure and heart failure group model was established by adenine perfusion combined with subcutaneous injection of isoproterenol.The validity of constructed models was evaluated by creatinine(SCr),urea nitrogen(BUN)and BNP levels,renal ultrasound and ultrasonic cardiogram examination results.The levels of C-reactive protein(CRP)and YKL-40 were detected by ELISA,and the YKL-40 mRNA expression level in kidney and heart tissues was measure by RT-qPCR.The Image J software was used to calculate the collagen fiber area of the Masson staining results.Results Except the blank control group,the mice weights in the other 3 groups were decreased,and the differences were statistically significant(P＜0.05).SCr,BUN,average renal cross sectional area,average renal volume and renal CVF in the renal failure group and renal combined heart failure group were higher than those in the blank control group and heart failure group(P＜0.05).The levels of LVEF,LVCO,LVSV,LVFS,LVPWd and LVPWs in the heart failure group and renal combined heart failure group were lower than those in the blank control group and renal failure group(P＜0.05).LVEF and LVFS in the renal combined heart failure group were higher than those in the heart failure group(P＜0.05).Compared with the blank control group,the serum CRP and YKL-40 levels in the other three groups were higher(P＜0.05);the CRP and YKL-40 levels in the renal combined heart failure group were higher than those in the renal failure group and heart failure group(P＜0.05).In the myocardial tis-sues,the YKL-40 mRNA expression level in the heart failure group and renal combined heart failure group was higher than those in the blank control group and renal failure group(P＜0.05).YKL-40 had the correla-tion with CRP(r=0.88,P＜0.05).Serum YKL-40 had the correlation with renal tissue YKL-40 gene expres-sion(r=0.77,P＜0.05),and had the correlation with the renal tissue CVF(r=0.89,P＜0.05).Conclusion YKL-40 has the influencing effect on renal failure complicating heart dysfunction,and could serve as the biomarker to mo-nitor the renal insufficiency complicating heart function abnormality.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Objective To explore the role of different CVP levels in the occurence and development of sepsis-associated acute kid-ney injury(SA-AKI).Methods Sepsis model was induced using the cecal ligation and puncture(CLP)method for 24h in male SD rats,with a sham group as the control.The rats in two groups were intravenously infused with Ringer's solution to induce an increase in CVP to 10,15 and 20mmHg,respectively.The hemodynamic parameters including mean arterial pressure(MAP),heart rate(HR),and arterial blood lactate(Lac)were dynamically monitored in rats.And side stream darkfield imaging(SDF)technique was used to de-tect the renal cortex microcirculation perfusion parameters including perfused small vessel density(PVD)and microvascular flow index(MFI).Renal injury markers including serum creatinine(CRE),urine neutrophil gelatinase associated lipocalin(NGAL),renal inflam-matory factor interleukin-6(IL-6)levels and renal histopathological changes were also detected.Results Compared with the sham group,the MAP of CLP rats significantly decreased,while HR and Lac significantly increased(P＜0.05).The renal PVD and MFI were significantly decreased(P＜0.05),while serum CRE,urine NGAL,and renal IL-6 were significantly increased(P＜0.05).Com-pared with CVP 10mmHg,the PVD and MFI of CLP rats were significantly decreased at CVP 20mmHg(P＜0.05);The PVD and MFI of sham group at CVP 15mmHg and 20mmHg were significantly lower than those of the CVP at CVP 10mmHg(P＜0.05).The IL-6 of CLP rats at CVP 15mmHg was significantly higher than that at CVP 10mmHg(P＜0.05),and the IL-6 levels at CVP 20mmHg were significantly higher than at CVP 15mmHg(P＜0.05).In CLP rats,increasing CVP led to cortical and medullary edema,vacuolar degen-eration of renal tubular epithelial cells,loss of brush borders,tubular obstruction,and disappearance of Bowman's space;medullary ede-ma was more pronounced than in the cortex.In the sham group,glomerular and tubular swelling occurred at CVP 20mmHg,and Bowman's space became narrower.Conclusion Excessive CVP levels can decrease renal cortical microcirculation perfusion and promote the acti-vation of local inflammation and renal tissue edema in CLP rats,which exerting a detrimental effect during the process of S-AKI.

Objective:To propose a novel refined subtyping of Neer type Ⅵ proximal humerus fracture-dislocation and explore its clinical application.Methods:A retrospective study was conducted to analyze the data of 36 patients who had been admitted to Department of Orthopaedics, Beijing Friendship Hospital between January 2018 and December 2022 for surgical treatment with proximal humeral internal locking system (PHILOS) for Neer type Ⅵ proximal humerus fracture-dislocation. There were 25 males and 11 females with an age of (46.1±4.7) years. According to the fracture-dislocation and the separation between the humeral head and the stem, the patients with Neer type Ⅵ proximal humerus fracture-dislocation were further subdivided into 3 subtype groups (known as STAB subtypes): subtype-T group (dislocation of the shoulder joint with macro-capitellar fracture, n=14), subtype-A group (proximal humerus fracture-dislocation without separation of the humeral head from the humeral stem, n=12), and subtype-B group (dislocation of the proximal humerus fracture with separation of the humeral head from the humeral stem, n=10). STAB subtyping was performed on the same imaging data from all the patients at admission and 2 weeks later by 4 surgeons with different qualifications. Interobserver and intraobserver agreements of the STAB typing were verified. The operation time, fracture healing time, visual analogue scale (VAS) pain score, Constant-Murley score, and complications were recorded for patients in the 3 subtype groups. Results:The differences in the preoperative general data were not statistically significant between the 3 subtype groups, indicating comparability ( P>0.05). All patients were followed up for (11.2±4.2) months. The inter-observer and intra-observer Kappa values for STAB subtyping were 0.94 and 0.95, respectively. For subtype-T group, subtype-A group, and subtype-B group, respectively, the operation time was (68.9±5.6) min, (90.0±5.2) min, and (113.0±9.2) min; the fracture healing time was (9.0±0.8) weeks, (10.3±1.2) weeks, and (11.8±0.9) weeks; the VAS scores at the last follow-up were 1.0(1.0, 2.0) points, 2.0(1.0, 2.0) points, 2.0(2.0, 3.0) points; the Constant-Murley scores at the last follow-up were (83.6±2.8) points, (74.5±3.0) points, and (62.7±5.5) points. The differences between the 3 subtype groups in the above items were statistically significant ( P<0.05). The overall success rate of closed reduction was 61.1% (22/36). In subtype-T, subtype-A, and subtype-B groups, respectively, the number of patients with successful closed reduction was 13, 7, and 2, while complications occurred in 2, 3, and 6 patients. The differences in closed reduction and complications among the 3 groups were statistically significant ( P<0.05). Conclusions:The STAB subtyping proposed in this study demonstrates strong intra- and inter-group consistency. Because the refined STAB subtyping can reveal differences among all the Neer type Ⅵ proximal humeral fractures and dislocations, it may provide more precise guidance for personalized clinical decision-making.

Objective:To evaluate the clinical efficacy and safety of erlotinib combined with albumin-bound paclitaxel and carboplatin in the treatment of patients with EGFR-mutation positive non-small cell lung cancer(NSCLC).Methods:A total of 80 patients with EGFR-mutation positive NSCLC treated at the Department of Oncology,Xijing Hospital from May 2019 to June 2021 were retrospectively selected for this study.According to their treatment methods,the patients were divided into two groups:the study group(n=38)and the control group(n=42).Both groups received erlotinib targeted therapy,while the study group also received combination chemotherapy with albumin-bound paclitaxel and carboplatin.The treatment efficacy[objective response rate(ORR),disease control rate(DCR)],immune function[CD3+,CD4+,CD8+,CD4+/CD8+,natural killer(NK)cells],survival status[3-years survival rate,overall survival(OS),progression-free survival(PFS),Karnofsky performance status(KPS)score],levels of tumor markers[carcinoembryonic antigen(CEA),cytokeratin fragment 19(CYFRA21-1),vascular endothelial growth factor(VEGF)],and the incidence of adverse reactions were compared between the two groups.Results:The DCR in the study group was significantly higher than that in control group(89.47%vs 42.86%)(P<0.05).The ORR in the study group was also higher than that in control group(36.84%vs 23.81%),but the difference was not statistically significant(P>0.05).After treatment,the study group showed significantly higher levels of CD3+,CD4+,NK cells and CD4+/CD8+ratio,and lower levels of CD8+compared to the control group(all P<0.05).There was no significant difference in 3-years survival rate between the two groups(P>0.05).However,the OS and PFS of the study group were longer than those of the control group(both P<0.05),and the KPS score was higher(P<0.05).The levels of CEA,CYFRA21-1 and VEGF in the study group were lower than those in control group(P<0.05).The incidence of bone marrow suppression was higher in the study group than in control group(P<0.05).Conclusion:Erlotinib targeted therapy combined with albumin-bound paclitaxel and carboplatin demonstrates good clinical efficacy in treating EGFR-mutation positive NSCLC.It reduces immune function damage,prolongs PFS in advanced NSCLC patients,and improves their quality of life,with a good safety profile.

Objective:To explore the clinical effect of observation and psychological intervention, splint or brace fixation as well as surgical treatment on habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature, evaluingating the epidemiological characteristics of HDH and the treatment scheme to maintain the stability of hip joint by systematic literature review in children.Methods:A retrospective analysis of the relevant data of 11 patients (12 hips) with HDH were treated from March 2007 to March 2021, including 2 boys and 9 girls. The age of the first dislocation was 2.25 (1.66, 3.75) years old and 4.33 (3.33, 6.17) years old at the age of diagnosis. At the same time, the relevant literature reports were searched from 1932 to 2022, and 24 HDH patients reports and clinical studies were confirmed to be included in this study according to the inclusion and exclusion criteria. The data of 33 patients (38 hips) with HDH who were obtained in the literature, including 5 boys and 28 girls. The age of the first dislocation was 2.00 (1.50, 2.00) years old and 4.00 (2.55, 5.00) years old at the age of diagnosis. A total of 44 patients (50 hips) with HDH who were analyzed, including gender, age of first dislocation, age of diagnosis, mode of stimulating dislocation, side and direction of dislocation, accompanying symptoms, family history, trauma history and imaging examination. The data of 41 patients with HDH (3 patients were excluded due to lack of treatment description) were treated with observation and psychological intervention in 19 patients, splint or brace fixation in 13 patients, and surgical treatment in 9 patients. The femoral neck-stem angle, acetabular index, central edge angle (CE angle) and Reimers instability index were measured by AutoCAD software, and the hip function was evaluated by Harris standard. Meantime, the disappearance time of dislocation was recorded.Results:The average follow-up time of 44 patients (50 hips) with HDH were 4.05±2.93 years old, and the time of disappearance of dislocation after treatment were 1.28±1.19 years old. Patients were diagnosed as 7 boys and 37 girls, 30 right and 8 left as well as 6 bilateral, the age of the first dislocation was 2.64±1.54 years old and 4.52±2.64 years old at the age of diagnosis. The data of 39 patients took hip flexion, adduction, internal rotation or hip flexion and adduction as the mode of stimulating dislocation. There were 43 patients with posterior dislocation, 41 patients with an audible "click" sound during dislocation, 36 patients with painless dislocation, and 37 patients with "vacuum phenomenon" were captured at the moment of dislocation. All patients with HDH had no specific family history and obvious history of trauma. There was no significant difference in general data between observation and psychological intervention group, splint or brace fixation group as well as surgical treatment group ( P>0.05). Harris standard to evaluate hip function, CE angle and Reimers instability index of the affected side were significantly different from those before and after treatment at the moment of dislocation ( H=127.51, P<0.001; H=55.70, P<0.001; H=54.69, P<0.001). Compared with the immediate disappearance of dislocation in the surgical treatment group, the disappearance time of dislocation in the observation and psychological intervention group and the splint or brace fixation group were significantly longer, and the difference was statistically significant ( H=20.83, P<0.001). Conclusion:Without specific family history and obvious trauma at young girls, painless posterior dislocation of hip with an audible "click" sound and "vacuum phenomenon" at the moment of dislocation are the significant epidemiological characteristics of HDH. Observation and psychological intervention, splint or brace fixation are recommended as the initial treatment scheme. When conservative treatment is ineffective, surgical treatment is needed to stabilize the hip joint quickly.

Objective:Compared with closed reduction and percutaneous pinning (CRPP) treatment, evaluating the clinical observation of utilizing a transolecranon pin joystick technique combined with CRPP in the teatment of multidirectionally unstable supracondylar humeral fractures in children.Methods:From thirty nine pediatric multidirectionally unstable supracondylar humeral fractures hospitalized between January 2012 and January 2019, twenty seven males (69.23%) and twelve females (30.77%) were included in the study, with a average age of 6.68±2.52 years (range, 2.17-13.75 y), twenty three fractures (65.7%) were treated with CRPP (CRPP group) and the remaining Sixteen fractures (41.03%) were treated utilizing a transolecranon pin joystick technique combined with CRPP (joystick group). Both groups were followed over 16 weeks. The paired sample t test or χ2 test and Fisher's exact test were used to compare the surgical time, times of fluoroscopy, quality of reduction and neurological or vascular complications, Baumann angle, carrying angle, lateralcapitellohumeral angle, postoperative range of motion as well as function-al outcomeduringthe Sixteen weeks and the last follow-up appointment. Results:All caseswere followed up for 1.98±1.43 years, and all fractures achieved clinical healing at 4 to 6 weeks postoperation. The surgical time and times of fluoroscopy were significantly shorter for patients in the joystick group (27.17±9.68 min, 24.25±5.92 times) when compared with CRPP group (48.59±15.75 min, 49.65±23.83 times, P<0.05). All cases showed restoration of the normal lateral capitellohumeral angle. Compared with Baumann angle of normal contralateral upper extremity during the sixteen weeks and the last follow-up appointment, the quality of reduction on the anteroposterior radiographic view was significantly better for patients in the joystick group than that of CRPP group ( P<0.05). The Baumann angle of the affected upper extremity was 77.70°±2.16°, and that of the normal contralateral upper extremity was 73.78°±4.04° in the CRPP group, joystick group was 73.06°±1.81° and 72.81°±3.45°, respectively at the sixteen weeks follow-up. The Baumann angle of the affected upper extremity was 77.13°±2.20°, and that of the normal contralateral upper extremity was 74.17°±4.17° in the CRPP group, joystick group was 72.69°±1.70° and 73.38°±3.48°, respectively at the last follow-up. The range of motion and clinical outcomes based on the criteria of Flynn were similar in both groups ( P<0.05). The elbow joint function of excellent and good rate of the criteria of Flynn was 82.61%, elbow flexion was 134.13°±8.61°, elbow extension was -3.48°±6.47° in the CRPP group, joystick group was 81.25%, 132.19°±9.48° and -3.44°± 4.37°, respectively at the sixteen weeks follow-up. The elbow joint function of excellent and good rate of the criteria of Flynn was 91.30%, elbow flexion was 140.14°±5.76°, elbow extension was -0.65±3.79° in the CRPP group, joystick group was 93.75%, 141.88°±5.12° and -0.31°±3.86°, respectivelyat the last follow-up. No immediate postoperative complications were observed. Conclusion:A transolecranon pin joystick technique combined with CRPP is a safe and effective method, can decrease surgical time and times of fluoroscopy and improve quality of reduction with no increasing risk of complications for closed reduction of multidirectionally unstable supracondylar humeral fractures in children.

Objective To study the physical characteristics of the OPEN stereotactic body radiotherapy system for the clinical application. Methods The 0. 125cc ioniztion chamber, 160 mm polystyrene sphere model,Gafchromic EBT2 films and IBA film analysis software were used to evaluated the focus position tolerance,dose rate,repeatability,linear relation,penumbra and composite error of the OPEN stereotactic body gamma knife. We used the DTA method to verify the accuracy of dose distribution between the plans and measured value. Resualts The focus error was 0. 36 mm,max dose rate tolerance 3%,linear relation error 2%,repeatability error 0. 3%,composited error 2. 5 mm. There was 90% pass rate when the distance away from test point was less than 2 mm and the dose error was set less than 5 % . Conclusions Parts of the test resualts were similar to the head gamma knife national protocal of OPEN stereotatic body gamma knife. The deliver dose distribution can meet the clinic need.

ObjectiveTo investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury.MethodsNine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew.ResultsThe mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome.ConclusionsSegond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.