Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

Isotretinoin is a highly effective and commonly used drug in the clinical treatment of severe acne, but its significant reproductive toxicity limits its clinical application. Current literature studies have shown that isotretinoin exerts widespread effects on the reproductive system through multiple pathways, including interference with the retinoic acid signaling pathway, induction of oxidative stress, and apoptosis. Therefore, in-depth dissection of its reproductive toxicity mechanisms, optimization of clinical risk management strategies, and development of safer alternative drugs are of great clinical and practical significance. Future research may focus on deepening mechanisms under the framework of precision medicine, individualized prevention and control strategies, and drug innovation to balance drug efficacy and safety.This article systematically reviews the toxic effects of isotretinoin on the reproductive system, including teratogenicity, its impact on female and male reproductive function , and explores in depth its molecular mechanisms, and clinical risk management strategies.

Isotretinoin is a highly effective and commonly used drug in the clinical treatment of severe acne, but its significant reproductive toxicity limits its clinical application. Current literature studies have shown that isotretinoin exerts widespread effects on the reproductive system through multiple pathways, including interference with the retinoic acid signaling pathway, induction of oxidative stress, and apoptosis. Therefore, in-depth dissection of its reproductive toxicity mechanisms, optimization of clinical risk management strategies, and development of safer alternative drugs are of great clinical and practical significance. Future research may focus on deepening mechanisms under the framework of precision medicine, individualized prevention and control strategies, and drug innovation to balance drug efficacy and safety.This article systematically reviews the toxic effects of isotretinoin on the reproductive system, including teratogenicity, its impact on female and male reproductive function , and explores in depth its molecular mechanisms, and clinical risk management strategies.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

OBJECTIVE To analyze the factors affecting the inclusion of Chinese patent medicines in China’s National reimbursement drug list （NRDL）， and assist these medicines in fully reflecting their actual value in the reimbursement admission process. METHODS From the official website of the China’s National Healthcare Security Administration， the application materials of Chinese patent medicines outside the list that passed the formal review from 2021 to 2023 were obtained， including basic information on the medicines， safety， efficacy， innovation and heritage information， and supplemented with references from the pharmacopeia and the Yaozhi Database. Economic information and enterprise information were obtained through websites such as the Yaozhi Database. Univariate analysis， multivariate Logistic regression analysis and stepwise regression analysis were conducted on the initial application information and admission outcomes of the medicines. Sensitivity analysis was also performed on medicines that applied multiple times in different years as independent samples. RESULTS & CONCLUSIONS There were 27 Chinese patent medicines that passed the formal review from 2021 to 2023， involving 37 applications. The univariate analysis results showed that medicines with descriptions of traditional Chinese medicine （TCM） syndrome types， clear adjustment information for medication plans for specific population groups， short time to market in the indications of the package insert， registered as Class 1 to 6 following or class Ⅰ innovative TCM/class Ⅲ ancient classic prescription compound TCM registered， and those produced by enterprises listed in the “Top 100 Chinese Pharmaceutical Industry Enterprises” list for the current year were more likely to be included in the NRDL （P＜0.05）. The results of the multivariate Logistic regression analysis were not statistically significant， but the stepwise regression results indicated good consistency with the univariate analysis. The results of the sensitivity analysis were consistent with the trend of basic analysis. It is recommended that Chinese patent medicine enterprises further clarify the description of product instructions， expand innovation capabilities， inherit and develop ancient classic prescriptions， and promptly complete clinical trial evidence.

Objective: To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods: Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results: Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

Objective To investigate the predictive value of metabolic syndrome (MS) on new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 89 553 subjects who participated health examination at the Kailuan General Hospital Affiliated to the North China University of Science and Technology,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected.According to the diagnostic criteria of MS published by International Diabetes Federation,all the patients were divided into 4 groups,including 70 657 without MS in the normal group,14 075 corresponded with 3 diagnostic criteria of MS in the MS-3 group,4 556 corresponded with 4 diagnostic criteria of MS in the MS-4 group and 265 corresponded with 5 diagnostic criteria of MS in the MS-5 group.Health examinations were applied to all subjects by the fixed team of doctors at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 4 groups;(2) incidence of cholelithiasis in the 4 groups;(3) risk factors analysis affecting new-onset cholelithiasis.Measurement data with normal distribution were represented as (x) ± s and comparisons among groups were analyzed using the one-way ANOVA.Pairwise comparison and homogeneity of variance were done using the LSD test.Heterogeneity of variance was done using the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q) and comparisons among groups were analyzed using the nonparametric Kruskal-Wallis test.Comparisons of count data were analyzed by the chi-square test.The incidence of cholelithiasis in the 4 groups were calculated by the Kaplan-Meier method and comparisons of incidence were done by the Log-rank test.The COX proportional hazards model was used to analyze the hazard ratios (HR) and 95％ confidence interval (95％ CI) of MS on new-onset cholelithiasis.Results (1) Comparisons of clinical characteristics among the 4 groups:age,sex (male),systolic blood pressure (SBP),diastolic blood pressure (DBP),waistline,triglyceride (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),fasting blood glucose,BMI,cases with hypertension,diabetes,drinking,smoking and physical exercise were (50± 12) years,52 895,(127 ± 20) mmHg (1 mmHg =0.133 kPa),(81 ± 11) mmHg,(85±9)cm,1.14 mmol/L (range,0.83-1.56 mmol/L),(4.9±1.1) mmol/L,(1.56±0.39)mmol/L,(5.2± 1.3)mmol/L,(24.5±3.3) kg/m2,24 016,7 696,11 636,20 689,10 245 in the normal group and (54± 11)years,12905,(142±19)mmHg,(90±11)mmHg,(94±8)cm,2.08 mmol/L (range,1.51-3.04 mmol/L),(5.1±1.3)mmol/L,(1.50±0.42)mmol/L,(6.3±2.1)mmol/L,(27.1±3.2) kg/m2,10 031,5 737,3 090,4 762,2 353 in the MS-3 group and (54±10)years,4 556,(146±19)mmHg,(92±11)mmHg,(97±7)cm,2.57 mmol/L (range,2.03-3.80 mmol/L),(5.2± 1.4)mmol/L,(1.44±0.45)mmol/L,(7.2±2.4)mmol/L,(28.1±3.1)kg/m2,3 696,2 971,1 091,1 699,867 in the MS-4 group and (56±11)years,265,(146± 17)mmHg,(92±11)mmHg,(98±6)cm,2.60 mmol/L (range,2.06-3.91 mmol/L),(4.9±1.1)mmol/L,(0.86±0.14) mmol/L,(7.7± 2.9) mmol/L,(28.7 ± 2.9) kg/m2,221,196,62,93,78 in the MS-5 group,respectively,with statistically significant differences among the 4 groups (F =481.40,x2 =3 359.07,F =3 551.06,3 280.16,5 915.20,x2 =18 358.71,F=211.30,473.42,4 168.34,3 909.75,x2 =9 829.51,14 449.74,375.78,225.14,145.73,P ＜ 0.05).(2) Incidence of cholelithiasis in the 4 groups:89 553 subjects were observed for (8.0± 1.1) years,and 4 313 had new-onset cholelithiasis with a cumulative incidence of 4.8％.The cumulative incidences of cholelithiasis in the normal,MS-3,MS-4 and MS-5 groups were respectively 4.5％,5.6％,6.3％ and 13.2％,with a statistically significant difference among the 4 groups (x2 =89.96,P＜ 0.05).There were statistically significant differences in the cumulative incidences of cholelithiasis among the normal,MS-3,MS-4 and MS-5 groups (x2=28.56,29.25,43.48,17.13,35.75,16.82,P＜0.05).(3) Risk factors analysis affecting new-onset cholelithiasis:results of COX proportional hazards model showed that hazard of the new-onset cholelithiasis in the normal group was increased compared with that in the MS-3,MS-4 and MS-5 groups with adjustment for sex,age,high-sensitivity C-reactive protein,smoking,drinking and physical exercise (HR=1.16,1.33,2.68,95％CI:1.07-1.26,1.17-1.51,1.92-3.74,P＜0.05).Conclusion MS is an independent risk factor of new-onset cholelithiasis,and the increased incidence risk of new-onset cholelithiasis is consistent with subjects corresponded with diagnostic criteria of MS.

BACKGROUND:In previous experiments, TiO2-xNy OBJECTIVE:To study the friction properties of orthodontic brackets coated with TiO-coated bracket has been confirmed to have excelent antibacterial properties and biological safety performance. 2-xNy METHODS: TiO film. 2-xNy film was prepared by radiofrequency magnetron sputtering on MBT bracket (0.022″). The TiO 2-x N y RESULTS AND CONCLUSION: TiO-coated brackets were analyzed by X-ray diffraction and scanning electron microscopy observations. The coefficient of static friction and coefficient of kinetic friction between the wires (0.012″, 0.014″, 0.016″) and orthodontic brackets were calculated. 2-xNy film on the bracket was of anatase structure, which was compact and had good crystalinity. Under dry condition, the coefficient of static friction and kinetic friction of the brackets coated with TiO2-xNy were less than those of ordinary brackets; under wet condition, the coefficients of static friction and kinetic friction of the brackets coated with TiO2-xNy were less than those of ordinary brackets, but the difference was not statisticaly significant. Nano-TiO2-xNy film can reduce the friction between bracket and archwire, which wil offer a novel opportunity to significantly reduce the friction during tooth movement.

Objective To study the relationship of insulin-like growth factor-Ⅰ receptor(IGF-ⅠR)and carcinogenesis of gastric cancer.Methods The expression of IGF-ⅠR was detected in 40 cases of resected gastric cancer tissues and adjacent normal gastric mucosa by immunohistochemistry.The expression of IGF-ⅠR in gastric cancer cell lines(MGC803 and SGC7901)was detected by Western Blot.siRNAs targeted to IGF-ⅠR were designed,synthesized and transfected into MGC803 cells,the changes of IGF-IR protein level were detected by Western Blot at 48 h after transfection,the cell proliferation was examined by MTT,and then the growth curve was obtained.Results The positive rate of IGF-IR expression in gastric cancer tissues was 75.5%,significantly higher than that of adjacent normal tissues (25%,P＜0.01).The expression level of IGF-IR was related with TNM stage,lymphnode metastasis (P＜0.05),but not related with sex,age,histological differentiation,invasion depth of gastric cancer (P＞0.05).Intense expression of IGF-ⅠR was showed in gastric cancer cell lines.The inhibition ratio of IGF-ⅠR expression in sigNAl group were 89.80%±4.10%,the cell proliferation decreased to mininlunl level at the fifth day aftertransfection(by 29.0%±4.0%of mock-treated group),the cell number decreased by 21.15%±1.10%of mock treated group at the same time.Conclusions IGF-ⅠR is over-expressed in gastric cancer cells and can be effectively silenced by RNA interferes,therefore the growth of tmnor cell Was inhibited.Thus,it indicates that IGF-ⅠR may be a promising target for gene therapy of gastric cancer.

Aim To study the mechanism and inhibi-tory effect of Aescine on SGC-7901 cells in vitro.Methods MTT method was used to detect SGC-7901 proliferation.Flow cytometer method was used to determine cell cycles.AnnexinⅤ-FITC apoptosis derection kit was used to detect apoptosis of cells.Western blot was employed to analyze the expression of Bcl-2.Results MTT result showed that Aescine could significantly inhibit the growth of SGC-7901.AnnexinⅤ-FITC apoptosis derection kit and Western blot results suggested that Aescine could induce the apoptosis of SGC-7901.Conclusions Aescine can inhibit the growth of SGC-7901 and induce the apoptosis of cells in vitro.