Objective:To investigate the clinicopathological characteristics of adamantinomatous craniopharyngioma (ACP) and papillary craniopharyngioma (PCP).Methods:A total of 71 cases craniopharyngioma, included 52 cases of ACP and 19 cases of PCP, diagnosed at the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China from September 2019 to November 2023 were collected. Clinical pathological data were analyzed, immunohistochemical staining was performed, and mutations in the CTNNB1 and BRAF V600E genes were examined to identify differences between ACP and PCP.Results:The ACP cohort comprised 27 male and 25 female patients, with an age at onset ranging from 6 to 70 years, mean age (42.0±18.3) years. In contrast, the PCP group included 15 males and 4 females, with an age at onset spanning 28 to 74 years, mean age (51.0±13.3) years. The ACP group more commonly showed calcifications on imaging than the PCP group [92.3% (48/52) versus 11/19]. Partial tumor resection and the maximum diameter of the tumor were important factors affecting the recurrence of ACP. Whorled cell clusters, wet keratinization, stellate reticulum, cysts, and calcification were more often seen in ACP than PCP ( P<0.05). Immunohistochemically, all (100%,52/52) of the ACP showed nuclear β-catenin expression, with varying degrees of expression in the nodular whorls, and scattered cytoplasmic β-catenin expression. The BRAF V600E expression was found in the cytoplasm of all (19/19) PCP cases, but only non-specific BRAF V600E nuclear positivity was observed in ACP cases. Molecular testing showed that the mutation rate of the CTNNB1 gene in ACP was 22.7% (5/22), and the mutation rate of the BRAF V600E in PCP was 19/19. Conclusions:ACP and PCP have different age at onset, radiological features, histopathological morphology, and genetic alterations. Proper use and interpretation of immunohistochemical results can help distinguish between ACP and PCP, while molecular testing can be used as an auxiliary diagnostic modality.

Objective:To assess the prognostic impact of the thoracic aorta and aortic valve calcification volume (TAC, AVC) score based on CT measurementsin patients undergoing transcatheter aortic valve implantation (TAVI).Methods:We retrospectively analyzed 102 patients who underwent TAVI for severe aortic stenosis from March 2018 to April 2022 at Fuwai Central China Cardiovascular Hospital. The patients were stratified into low TAC and AVC group (TAC low, AVC low) and high TAC and AVC group (TAC high, AVC high) based on median TAC and AVC. The independent risk factors affecting the prognosis of TAVI patients were analyzed using univariate and multivariate Cox proportional risk regression, and the independent risk factors affecting the prognosis of TAVI were analyzed by survival curve. Results:A total of 102 patients were included with a median follow-up of 695 (602, 923) days, during which 9 (8.8%) all-cause deaths and 33 (32.4%) composite end-point events occurred. Univariate Cox risk regression analysis found that TAC was a risk factor for all-cause mortality events in TAVI patients ( P=0.039), TAC and AVC were risk factors for composite endpoint events in TAVI patients ( P=0.047, 0.035).TAC was an independent predictor of all-cause mortality after TAVI in multivariate analysis ( HR=8.971, 95% CI 1.121-71.790, P=0.039), and TAC and AVC were independent risk factors for composite endpoint events after TAVI ( HR=2.243, 95% CI 1.099-4.578, P=0.026; HR=2.346, 95% CI 1.146-4.804, P=0.020). Kaplan-Meier survival curves showed that high TAC and AVC scores increased the risk of end-point events ( P<0.05). Conclusion:CT-quantified TAC and AVC volume scores are independent prognostic markers in TAVI patients, with greater calcification burden portending poorer clinical outcomes.

Objective:To investigate the current status of nutritional support specialist nurses' knowledge, attitude and practice about nutrition nursing practice and analyze their influencing factors, so as to provide reference for optimizing and improving the level of nutritional support specialist nurses' knowledge, attitude and practice, and constructing a training program for nutritional support specialist nurses.Methods:From October to November 2023, 557 nutritional support specialist nurses in 28 provinces, autonomous regions, and municipalities directly under the central government of China were selected for the survey using the convenience sampling method. General information questionnaire and Nutrition Nursing Practice Knowledge, Attitude and Practice Questionnaire were used to conduct the survey. Multiple linear regression was used to explore the influencing factors of knowledge, attitude and practice.Results:A total of 557 questionnaires were distributed and 507 questionnaires were effectively recovered, with an effective recovery rate of 91.0%. The nutrition nursing practice knowledge dimension scores, attitude dimension scores, and practice dimension scores of 507 nutritional support specialist nurses were 30.00 (28.00, 31.00) , 47.00 (41.00, 50.00) , (22.65±6.77) , respectively. Multiple linear regression analyses showed that education was an influencing factor in the knowledge dimension of nutrition nursing practice among nutritional support nurse specialists ( P<0.05) ; title, hospital level, and years of experience as a nutritional support nurse specialist were influencing factors in the attitude dimension of nutrition nursing practice ( P<0.05) . Conclusions:Nutritional support specialist nurses have a good knowledge base of nutrition nursing practice and a positive attitude, but their practices need to be further improved. Knowledge, attitude, and practice are affected by multiple factors such as education, title, hospital level, and number of years in the professional field. In the process of nurse specialist training, managers should pay attention to the learning needs of nurses at different levels, carry out targeted training, establish a standard workflow for nurse specialists, and emphasize the construction of talents in primary hospitals, so as to promote the high-quality development of nutrition support specialist nurses.

Objective:To investigate the clinicopathological characteristics of adamantinomatous craniopharyngioma (ACP) and papillary craniopharyngioma (PCP).Methods:A total of 71 cases craniopharyngioma, included 52 cases of ACP and 19 cases of PCP, diagnosed at the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China from September 2019 to November 2023 were collected. Clinical pathological data were analyzed, immunohistochemical staining was performed, and mutations in the CTNNB1 and BRAF V600E genes were examined to identify differences between ACP and PCP.Results:The ACP cohort comprised 27 male and 25 female patients, with an age at onset ranging from 6 to 70 years, mean age (42.0±18.3) years. In contrast, the PCP group included 15 males and 4 females, with an age at onset spanning 28 to 74 years, mean age (51.0±13.3) years. The ACP group more commonly showed calcifications on imaging than the PCP group [92.3% (48/52) versus 11/19]. Partial tumor resection and the maximum diameter of the tumor were important factors affecting the recurrence of ACP. Whorled cell clusters, wet keratinization, stellate reticulum, cysts, and calcification were more often seen in ACP than PCP ( P<0.05). Immunohistochemically, all (100%,52/52) of the ACP showed nuclear β-catenin expression, with varying degrees of expression in the nodular whorls, and scattered cytoplasmic β-catenin expression. The BRAF V600E expression was found in the cytoplasm of all (19/19) PCP cases, but only non-specific BRAF V600E nuclear positivity was observed in ACP cases. Molecular testing showed that the mutation rate of the CTNNB1 gene in ACP was 22.7% (5/22), and the mutation rate of the BRAF V600E in PCP was 19/19. Conclusions:ACP and PCP have different age at onset, radiological features, histopathological morphology, and genetic alterations. Proper use and interpretation of immunohistochemical results can help distinguish between ACP and PCP, while molecular testing can be used as an auxiliary diagnostic modality.

Objective:To assess the prognostic impact of the thoracic aorta and aortic valve calcification volume (TAC, AVC) score based on CT measurementsin patients undergoing transcatheter aortic valve implantation (TAVI).Methods:We retrospectively analyzed 102 patients who underwent TAVI for severe aortic stenosis from March 2018 to April 2022 at Fuwai Central China Cardiovascular Hospital. The patients were stratified into low TAC and AVC group (TAC low, AVC low) and high TAC and AVC group (TAC high, AVC high) based on median TAC and AVC. The independent risk factors affecting the prognosis of TAVI patients were analyzed using univariate and multivariate Cox proportional risk regression, and the independent risk factors affecting the prognosis of TAVI were analyzed by survival curve. Results:A total of 102 patients were included with a median follow-up of 695 (602, 923) days, during which 9 (8.8%) all-cause deaths and 33 (32.4%) composite end-point events occurred. Univariate Cox risk regression analysis found that TAC was a risk factor for all-cause mortality events in TAVI patients ( P=0.039), TAC and AVC were risk factors for composite endpoint events in TAVI patients ( P=0.047, 0.035).TAC was an independent predictor of all-cause mortality after TAVI in multivariate analysis ( HR=8.971, 95% CI 1.121-71.790, P=0.039), and TAC and AVC were independent risk factors for composite endpoint events after TAVI ( HR=2.243, 95% CI 1.099-4.578, P=0.026; HR=2.346, 95% CI 1.146-4.804, P=0.020). Kaplan-Meier survival curves showed that high TAC and AVC scores increased the risk of end-point events ( P<0.05). Conclusion:CT-quantified TAC and AVC volume scores are independent prognostic markers in TAVI patients, with greater calcification burden portending poorer clinical outcomes.

Objective:To investigate the current status of nutritional support specialist nurses' knowledge, attitude and practice about nutrition nursing practice and analyze their influencing factors, so as to provide reference for optimizing and improving the level of nutritional support specialist nurses' knowledge, attitude and practice, and constructing a training program for nutritional support specialist nurses.Methods:From October to November 2023, 557 nutritional support specialist nurses in 28 provinces, autonomous regions, and municipalities directly under the central government of China were selected for the survey using the convenience sampling method. General information questionnaire and Nutrition Nursing Practice Knowledge, Attitude and Practice Questionnaire were used to conduct the survey. Multiple linear regression was used to explore the influencing factors of knowledge, attitude and practice.Results:A total of 557 questionnaires were distributed and 507 questionnaires were effectively recovered, with an effective recovery rate of 91.0%. The nutrition nursing practice knowledge dimension scores, attitude dimension scores, and practice dimension scores of 507 nutritional support specialist nurses were 30.00 (28.00, 31.00) , 47.00 (41.00, 50.00) , (22.65±6.77) , respectively. Multiple linear regression analyses showed that education was an influencing factor in the knowledge dimension of nutrition nursing practice among nutritional support nurse specialists ( P<0.05) ; title, hospital level, and years of experience as a nutritional support nurse specialist were influencing factors in the attitude dimension of nutrition nursing practice ( P<0.05) . Conclusions:Nutritional support specialist nurses have a good knowledge base of nutrition nursing practice and a positive attitude, but their practices need to be further improved. Knowledge, attitude, and practice are affected by multiple factors such as education, title, hospital level, and number of years in the professional field. In the process of nurse specialist training, managers should pay attention to the learning needs of nurses at different levels, carry out targeted training, establish a standard workflow for nurse specialists, and emphasize the construction of talents in primary hospitals, so as to promote the high-quality development of nutrition support specialist nurses.

Objective:To investigate the clinical and radiologic characteristics of children with congenital pseudarthrosis of the tibia (CPT) in a single center.Methods:This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 497 children(507 limbs) with CPT who were treated at Department of Orthopedics, the Children′s Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2011 to December 2020 were collected. Baseline data included gender, age at initial visit, age at onset of symptoms, accompanying symptoms, domicile, whether first treated at our hospital, and treatment-related information such as surgical or conservative treatment, surgical complications, etc., were extracted and analyzed using the health information system. Imaging data of the children, including Crawford classification, bilateral leg lengths, presence of fibular pseudarthrosis, and location of pseudarthrosis along the tibia segment, were analyzed using the Picture Archiving and Communication System. Data were compared using independent sample t test or χ2 tests. Results:Among 497 children with CPT, there were 305 males (61.4%) and 192 females (38.6%). The age at initial visit was (3.6±3.2) years (range: 0.1 to 16.2 years). Neurofibromatosis type 1 (NF1) symptoms were positive in 340 children (68.4%), and negative in 157 children (31.6%). Among NF1-positive children, those with symptoms onset before 1 year of age were significantly more than NF1-negative children (74.1%(252/340) vs. 66.2%(104/157); χ2=9.24, P=0.001), and the proportion of fractures (92.9%,316/340) was significantly higher than that in the NF1-negative group (84.7%,133/157) ( χ2=8.33, P=0.004). According to imaging data, Crawford type Ⅳ was the most common type, with 321 limbs (63.3%), followed by type Ⅱ in 100 limbs (19.7%), type Ⅲ in 54 limbs (10.7%) and type Ⅰ in 32 limbs (6.3%). Pseudarthrosis occurred in the proximal third of the tibia in 14 limbs (2.8%), in the middle third in 185 limbs (36.5%), and in the distal third in 308 limbs (60.8%). Seventy-four children (14.9 %) had associated fibular pseudarthrosis. The lateral proximal tibial angle was 86.91°±5.21°(range: 72.17° to 102.08°), and the lateral distal tibial angle was 87.27°±10.73°(range: 51.07° to 128.17°). A total of 421 children (84.7%) underwent surgical treatment with (3.1±2.4) surgeries performed per child (range:0 to 12 surgeries); 76 children (15.3%) received conservative treatment. Postoperative complications mainly included ankle valgus (77 cases), leg length discrepancy (71 cases),refracture (48 cases), osteomyelitis (11 cases), and hardware failure (10 cases). NF1-positive children underwent more surgeries than NF1-negative children ((5.1±2.2)times vs.(2.1±1.8)times; t=14.93, P<0.01). Conclusions:Crawford type Ⅳ is the most common type of CPT in children in this study. CPT predominantly occurs in the middle or distal third of the tibia. The majority of children with CPT experienced symptoms and were seen at outpatient clinics before the age of 3 years. The main surgical complications currently associated with CPT treatment are ankle valgus and leg length discrepancy. Compared with CPT without NF1, children with NF1-positive CPT tend to have earlier symptom onset and may require more frequent treatments.

Objective:To investigate the clinical and radiologic characteristics of children with congenital pseudarthrosis of the tibia (CPT) in a single center.Methods:This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 497 children(507 limbs) with CPT who were treated at Department of Orthopedics, the Children′s Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2011 to December 2020 were collected. Baseline data included gender, age at initial visit, age at onset of symptoms, accompanying symptoms, domicile, whether first treated at our hospital, and treatment-related information such as surgical or conservative treatment, surgical complications, etc., were extracted and analyzed using the health information system. Imaging data of the children, including Crawford classification, bilateral leg lengths, presence of fibular pseudarthrosis, and location of pseudarthrosis along the tibia segment, were analyzed using the Picture Archiving and Communication System. Data were compared using independent sample t test or χ2 tests. Results:Among 497 children with CPT, there were 305 males (61.4%) and 192 females (38.6%). The age at initial visit was (3.6±3.2) years (range: 0.1 to 16.2 years). Neurofibromatosis type 1 (NF1) symptoms were positive in 340 children (68.4%), and negative in 157 children (31.6%). Among NF1-positive children, those with symptoms onset before 1 year of age were significantly more than NF1-negative children (74.1%(252/340) vs. 66.2%(104/157); χ2=9.24, P=0.001), and the proportion of fractures (92.9%,316/340) was significantly higher than that in the NF1-negative group (84.7%,133/157) ( χ2=8.33, P=0.004). According to imaging data, Crawford type Ⅳ was the most common type, with 321 limbs (63.3%), followed by type Ⅱ in 100 limbs (19.7%), type Ⅲ in 54 limbs (10.7%) and type Ⅰ in 32 limbs (6.3%). Pseudarthrosis occurred in the proximal third of the tibia in 14 limbs (2.8%), in the middle third in 185 limbs (36.5%), and in the distal third in 308 limbs (60.8%). Seventy-four children (14.9 %) had associated fibular pseudarthrosis. The lateral proximal tibial angle was 86.91°±5.21°(range: 72.17° to 102.08°), and the lateral distal tibial angle was 87.27°±10.73°(range: 51.07° to 128.17°). A total of 421 children (84.7%) underwent surgical treatment with (3.1±2.4) surgeries performed per child (range:0 to 12 surgeries); 76 children (15.3%) received conservative treatment. Postoperative complications mainly included ankle valgus (77 cases), leg length discrepancy (71 cases),refracture (48 cases), osteomyelitis (11 cases), and hardware failure (10 cases). NF1-positive children underwent more surgeries than NF1-negative children ((5.1±2.2)times vs.(2.1±1.8)times; t=14.93, P<0.01). Conclusions:Crawford type Ⅳ is the most common type of CPT in children in this study. CPT predominantly occurs in the middle or distal third of the tibia. The majority of children with CPT experienced symptoms and were seen at outpatient clinics before the age of 3 years. The main surgical complications currently associated with CPT treatment are ankle valgus and leg length discrepancy. Compared with CPT without NF1, children with NF1-positive CPT tend to have earlier symptom onset and may require more frequent treatments.

Objective:To investigate the clinicopathological features of Crooke cell tumor of adrenocorticotropic hormone differentiation specific transcription factor (TPIT, also known as transcription factor 19, TBX19) lineage neuroendocrine tumors.Methods:Six cases of Crooke cell tumor diagnosed at the First Affiliated Hospital of University of Science and Technology of China, Hefei, China from October 2019 to October 2023 were collected. The clinical and pathological features of these cases were analyzed.Results:Among the six cases, one was male and five were female, with ages ranging from 26 to 75 years, and an average age of 44 years. All tumors occurred within the sella turcica. Clinical presentations included visual impairment in two cases, menstrual disorders in one case, Cushing′s syndrome in one case, headache in one case, and one asymptomatic case discovered during a physical examination. Preoperative serum analyses revealed elevated levels of cortisol and adrenocorticotropic hormones in two cases, elevated cortisol in two cases, elevated adrenocorticotropic hormone in one case, and one case with a mild increase in prolactin due to the pituitary stalk effect. Magnetic resonance imaging revealed uneven enhancement of masses with maximum diameters ranging from 1.7 to 3.2 cm, all identified as macroadenomas. Microscopically, tumor cells exhibited irregular polygonal shapes, solid sheets, or pseudo-papillary arrangements around blood vessels. The cell nuclei were eccentric or centrally located, varying in size, with abundant cytoplasm. Some tumor cells showed perinuclear halo. Immunohistochemistry demonstrated diffuse strong positivity for TPIT in five cases, focal weak positivity for TPIT in one case, diffuse strong positivity for adrenocorticotropic hormone in all cases, and faint staining around the nuclei in a few cells. CK8/18 showed a strong positive ring pattern in more than 50% of tumor cells, focal weak positive expression of p53, and the Ki-67 positive index ranged 1%-5%. Periodic acid-Schiff staining revealed positive cytoplasm and negative perinuclear areas.Conclusions:Crooke cell tumor is a rare type of pituitary neuroendocrine tumors. Its pathological characteristics include a distinctive perinuclear clear zone and immunohistochemical markers, such as CK8/18 exhibiting a ring or halo pattern. This entity represents a high-risk subtype among pituitary neuroendocrine tumors, displaying a high risk of invasion and a propensity for recurrence. Accurate diagnosis is crucial for the postoperative follow-up and multimodal treatment planning.

Objective:To explore the risk factors associated with tibia fractures in children with congenital anterolateral bowing of the tibia (ALBT).Methods:A retrospective analysis was conducted on data from 87 children diagnosed with ALBT at the Children's Hospital of Hunan Province from January 2012 to January 2020. The collected data included age at initial diagnosis, affected limb side, whether there was a concomitant type I neurofibromatosis, whether there was a concomitant fibular pseudoarthrosis, whether there was concomitant ankle joint deformity, whether there was bone cystic change in the region of tibial bowing deformity, location of the apex of the bowing deformity, diameter of the tibial bowing deformity on the affected side, diameter on the healthy side in the same plane as the tibial bowing deformity, angle of lateral bending deformity of the tibia, angle of anterior bending deformity of the tibia, occurrence of tibia fracture, history of trauma before fracture, location of fracture, and age at the time of fracture. The follow-up endpoint was January 2023. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values for the angles of lateral and anterior bending deformity of the tibia and the ratio of cross-sectional areas. The correlation between the above factors and tibial fractures in children was analyzed by single factor survival analysis, and the indicators with statistical significance were included in multivariate Cox proportional risk regression analysis to determine the risk factors for tibial fractures in children with ALBT.Results:Of the 87 children diagnosed with ALBT, the median age at initial diagnosis was 14.0 months (range, 1-93 months), with 42 males and 45 females, 44 left-sided and 43 right-sided cases. The median follow-up time for non-fracture cases was 42.0 months (range, 1-124 months). At the last follow-up, 43 children had experienced fractures, while 44 had not. The average time to fracture-free survival was 70.3 months, the median fracture-free survival time was 55.0 months, and the median survival time without fractures was 42.0 months. The ROC curve results indicated a cutoff value of 25.55° for the lateral bending angle of the tibia and 32.63° for the anterior bending angle of the tibia, with no statistically significant significance for the cross-sectional area ratio [AUC=0.54, 95% CI (0.42, 0.66), P=0.530]. Single-factor analysis of fracture-free survival suggested that there were statistically significant differences in the intergroup fracture-free survival rates of four factors: lateral bending angle of the tibia (χ 2=7.06, P=0.008), anterior bending angle of the tibia (χ 2=8.96, P=0.003), history of trauma (χ 2=18.26, P<0.001), and tibial bone cystic change (χ 2=4.30, P=0.038). The results of the multivariate Cox proportional hazards regression analysis showed that a lateral bending angle of the tibia&ge;25.55° ( HR=2.73, P=0.007), tibial bone cystic change ( HR=2.35, P=0.018), and history of trauma ( HR=2.65, P=0.004) were all positively correlated with fractures. Conclusion:The main risk factors for tibia fractures in children with ALBT include trauma, tibial bowing deformity with concomitant bone cystic change, and lateral bending angle of the tibia&ge;25.55°.