PURPOSE: This study aims to investigate the efficacy of novel distraction support (DS) in intramedullary nailing treatment for tibial shaft fracture. METHODS: The random controlled trial included adult patients with tibial shaft fractures who were treated with intramedullary nailing at the trauma center between July 2013 and December 2018. Participants were randomly assigned to either control group (n=43) or DS group (n=42) based on whether DS was used during the operation. All surgical procedures were conducted by a single, experienced surgeon. Parameters such as hospital stay, blood loss, operative time, infection, delayed union, and malalignment were recorded for assessment. Shapiro-Wilk test was used to assess normality, and the F test was adopted to measure variance homogeneity. Continuous variables were presented as mean±standard deviation and compared via independent samples t-tests. Categorical variables are expressed as percentages. The Pearson's Chi-squared or Fisher's exact test was used for categorical variables n (%). Two-sided p<0.05 indicated statistical significance. RESULTS: A total of 85 participants were enrolled in the study. All cases achieved acceptable reduction. The operative time was significantly shorter in the DS group than in control group ((75.3±10.5) min vs. (90.4±15.5) min, p<0.001). Additionally, the DS group showed lesser blood loss ((60.1±27.2) mL vs. (85.4±25.4) mL, p<0.001). No significant differences were observed between the 2 groups in terms of hospital stay ((9.4±2.7) days vs. (10.2±3.1) days, p=0.370), infection (3 (7.1%) vs. 2 (4.7%), p=0.978), delayed union (2 (4.8%) vs. 5 (11.6%), p=0.450), and malalignment (3 (7.1%) vs. 5 (11.6%), p=0.713). CONCLUSION The use of DS in intramedullary nailing surgery is effective. The application of this DS system may represent a valuable addition to future clinical practice.
Humans ; Fracture Fixation, Intramedullary/methods* ; Tibial Fractures/surgery* ; Male ; Female ; Adult ; Middle Aged ; Operative Time ; Length of Stay ; Young Adult ; Osteogenesis, Distraction/methods*

Music intervention is an innovative nursing method that integrates music,medicine,and psychology.It is safe,effective,and easy for implemention.It has demonstrated positive effects in alleviating psychotic symptoms,stabilizing emotions,and improving sleep,and it is gradually being applied in psychiatric disorders.This article provides a review of the theoretical basis and current research status of music intervention,and offers a perspective on future applications,with the aim of providing a reference for the application of music intervention in the rehabilitation nursing of mental illnesses.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Music intervention is an innovative nursing method that integrates music,medicine,and psychology.It is safe,effective,and easy for implemention.It has demonstrated positive effects in alleviating psychotic symptoms,stabilizing emotions,and improving sleep,and it is gradually being applied in psychiatric disorders.This article provides a review of the theoretical basis and current research status of music intervention,and offers a perspective on future applications,with the aim of providing a reference for the application of music intervention in the rehabilitation nursing of mental illnesses.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.

Objective:To investigate whether there are differences in clinical outcomes and perinatal outcomes associated with different initial dosages of gonadotropin (Gn) in expected poor prognosis young patients, diagnosed according to the POSEIDON criteria, undergoing the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol.Methods:This retrospective cohort study analyzed clinical data from patients who underwent their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)-fresh embryo transfer (ET) cycle at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University between January 1, 2016, and June 30, 2022. Patients included in the study were those who underwent ovarian stimulation with the early-follicular phase long-acting GnRH-a long protocol and young expected poor prognosis. Patients were divided into three groups based on the starting Gn dosage: low-dose group (Gn<225 U), medium-dose group (225 U≤Gn<300 U), and high-dose group (Gn=300 U). Clinical and perinatal outcomes were compared among the three groups. Results:A total of 1 659 cycles were included in the study, with 316 cycles in the low-dose group, 536 cycles in the medium-dose group, and 807 cycles in the high-dose group. The number of oocytes retrieved in the high-dose group [6.00 (4.00,9.00)] was less than that in the medium-dose group [8.00 (6.00,11.00)] and the low-dose group [11.00 (7.00,13.00)], which in the medium-dose group was less than that in the low-dose group, and the differences were statistically significant (all P<0.017). There were no significant statistical differences in oocyte maturation rate, normal fertilization rate of IVF/ICSI, or high-quality embryo rate among the three groups (all P>0.05). The blastocyst formation rates decreased sequentially in the low-dose group [20.33% (425/2 090)], medium-dose group [17.28% (510/2 951)], and high-dose group [14.62% (518/3 542)], with significant differences between each pair of groups (all P<0.017). There were no significant differences in clinical pregnancy rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate, chromosomal abnormalities in miscarriage tissues, or preterm birth rate among the three groups (all P>0.05). However, the live birth rate was significantly lower in the high-dose group [47.83% (386/807)] than in the low-dose group [57.28% (181/316), P=0.004]. After adjusting for confounding factors using multivariate logistic regression, the high starting Gn dosage was found to be an independent risk factor for decreased live birth rate (a OR=0.659, 95% CI: 0.462-0.941, P=0.022). There were no significant differences in perinatal outcomes among the groups, regardless of whether confounding factors were adjusted for (all P>0.05). Conclusion:In young patients with expected poor prognosis undergoing their first ovarian stimulation with the long-acting follicular phase protocol, increasing the starting Gn dosage does not increase the number of oocytes retrieved and is associated with a lower blastocyst formation rate and a reduced live birth rate, but does not increase the risk of adverse perinatal outcomes.

Objective:To investigate whether there are differences in clinical outcomes and perinatal outcomes associated with different initial dosages of gonadotropin (Gn) in expected poor prognosis young patients, diagnosed according to the POSEIDON criteria, undergoing the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol.Methods:This retrospective cohort study analyzed clinical data from patients who underwent their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)-fresh embryo transfer (ET) cycle at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University between January 1, 2016, and June 30, 2022. Patients included in the study were those who underwent ovarian stimulation with the early-follicular phase long-acting GnRH-a long protocol and young expected poor prognosis. Patients were divided into three groups based on the starting Gn dosage: low-dose group (Gn<225 U), medium-dose group (225 U≤Gn<300 U), and high-dose group (Gn=300 U). Clinical and perinatal outcomes were compared among the three groups. Results:A total of 1 659 cycles were included in the study, with 316 cycles in the low-dose group, 536 cycles in the medium-dose group, and 807 cycles in the high-dose group. The number of oocytes retrieved in the high-dose group [6.00 (4.00,9.00)] was less than that in the medium-dose group [8.00 (6.00,11.00)] and the low-dose group [11.00 (7.00,13.00)], which in the medium-dose group was less than that in the low-dose group, and the differences were statistically significant (all P<0.017). There were no significant statistical differences in oocyte maturation rate, normal fertilization rate of IVF/ICSI, or high-quality embryo rate among the three groups (all P>0.05). The blastocyst formation rates decreased sequentially in the low-dose group [20.33% (425/2 090)], medium-dose group [17.28% (510/2 951)], and high-dose group [14.62% (518/3 542)], with significant differences between each pair of groups (all P<0.017). There were no significant differences in clinical pregnancy rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate, chromosomal abnormalities in miscarriage tissues, or preterm birth rate among the three groups (all P>0.05). However, the live birth rate was significantly lower in the high-dose group [47.83% (386/807)] than in the low-dose group [57.28% (181/316), P=0.004]. After adjusting for confounding factors using multivariate logistic regression, the high starting Gn dosage was found to be an independent risk factor for decreased live birth rate (a OR=0.659, 95% CI: 0.462-0.941, P=0.022). There were no significant differences in perinatal outcomes among the groups, regardless of whether confounding factors were adjusted for (all P>0.05). Conclusion:In young patients with expected poor prognosis undergoing their first ovarian stimulation with the long-acting follicular phase protocol, increasing the starting Gn dosage does not increase the number of oocytes retrieved and is associated with a lower blastocyst formation rate and a reduced live birth rate, but does not increase the risk of adverse perinatal outcomes.

The prevalence of diabetes in China is increasing year by year， and has become a health issue of close concern to the whole society. Glucagon-like peptide-1 （GLP-1） receptor agonist （GLP-1RA）， as a new class of glucose-lowering drugs， is now widely used in the treatment of type 2 diabetes mellitus （T2DM） because of its significant glucose-lowering efficacy and low risk of hypoglycemia. As the level of evidence for its effects on improving cardiovascular system and renal protection and reducing body mass continues to improve， its status in the treatment guidelines for T2DM is gradually increasing. Currently， nine GLP-1RA drugs have been approved for the clinical treatment of T2DM in China. Although all of these drugs exert hypoglycemic effects based on the activation of GLP-1 receptors in the body， the differences in their own structures and natural GLP-1 amino acid homology lead to large differences in pharmacokinetic parameters and clinical efficacy among different analogs. In order to enable clinicians and pharmacists to have a full understanding of the characteristics and clinical evidence of these analogs and to better perform their therapeutic effects， Liaoning Provincial Pharmaceutical Society organized clinical medicine and pharmacy experts to develop a medication guide for nine GLP-1RA drugs to provide a reference for clinical medication needs and promote rational and standardized use by compiling and summarizing the pharmacological characteristics， clinical applications， adverse reactions， interactions， the medications in special populations and medication management.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of polyisobutylene （PIB）-type Gutong plaster （called “PIB Gutong plaster” for short） versus non-steroidal anti-inflammatory drugs （NSAIDs） in the treatment of osteoarthritis in Chinese adults. METHODS Based on a real-world study， after propensity score matching， the decrease in pain visual simulation score， utility increase， time to pain resolution， time to return to normal range of motion and total adverse events of PIB Gutong plaster versus three NSAIDs （celecoxib， diclofenac sodium， and ibuprofen） were evaluated. Cost-utility analysis was used to calculate the incremental cost-effectiveness ratio （ICER） of patients using PIB Gutong plaster versus the three NSAIDs from the perspective of the whole society， and sensitivity analysis was carried out. RESULTS In terms of effectiveness， the recovery time of joint activity in PIB Gutong plaster group was significantly longer than that in celecoxib group， the decrease in VAS score of PIB Gutong plaster was significantly higher than that of ibuprofen but significantly lower than that of diclofenac sodium； the time of pain disappearance was longer than that in diclofenac sodium group and ibuprofen group， and the increase in health utility was significantly lower than that in diclofenac sodium group （P＜0.05）. In terms of safety， there were no significant differences in the incidence and severity of adverse events of PIB Gutong plaster， compared with the three NSAIDs， without statistical significance （P＜0.05）. In terms of cost-effectiveness， compared with celecoxib and diclofenac sodium， PIB Gutong plaster was dominant. Compared with ibuprofen， the ICER value of PIB Gutong plaster was 178 611.58 yuan/QALY， indicating that at the current price， PIB Gutong plaster was cost-effective if the threshold was 3 times GDP per capita. The results of sensitivity analysis were consistent with those of basic analysis. CONCLUSIONS The efficacy of PIB Gutong plaster was better than that of ibuprofen， similar to that of celecoxib， but worse than that of diclofenac sodium， the safety was consistent with the three NSAIDs， and the cost-effectiveness of PIB Gutong plaster needs to be improved.