Background Per- and poly-fluoroalkyl substances (PFAS) can influence gestational diabetes mellitus (GDM); however, current studies on their association are limited and have yielded inconsistent findings. Objective To investigate the association between maternal exposure to PFAS, as measured by urinary concentrations in early pregnancy, and the risk of developing GDM. Methods Based on the Wuhu Birth Cohort in Anhui Province conducted between 2020 and 2023, this study included 1910 pregnant women. Urine samples were collected during the first trimester, and a 75 g oral glucose tolerance test (OGTT) was completed at 24–28 gestational weeks. The concentrations of six PFAS in urine were measured using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Participants were categorized into low, medium, and high exposure groups according to tertiles of individual PFAS concentrations. Logistic regression analysis was employed to assess the potential impact of early-pregnancy PFAS exposure levels on the risk of GDM, with stratified analyses by maternal age and fetal sex. A generalized weighted quantile sum regression (gWQS) model was applied to evaluate the relative weight distribution of the six PFAS in their mixture effect. Results The logistic regression results revealed that both medium exposure to perfluorohexane sulfonate (PFHxS) (OR=1.475, 95%CI: 1.040, 2.093) and high exposure to perfluorononanoic acid (PFNA) (OR=1.430, 95%CI: 1.013, 2.018) were positively associated with diagnosed GDM. This association was more pronounced among women older than 28 years. Among pregnant women carrying male fetuses, high-level exposures to per fluorohexanoic acid (PFHxA) (OR=1.708, 95%CI: 1.006, 2.899) and PFHxS (OR=2.116, 95%CI: 1.247, 3.584) showed positive associations with diagnosed GDM. In contrast, among those carrying female fetuses, moderate perfluorooctanesulfonic acid (PFOS) exposure was associated with a lower risk of GDM (OR=0.542, 95%CI: 0.311, 0.946). The gWQS results demonstrated that PFOS (0.48) and perfluorobutane sulfonate (PFBS) (0.34) contributed the most to the mixture effect. Conclusion Early-pregnancy exposure to PFAS (particularly PFHxS and PFNA) may be an etiological factor for GDM, with maternal age and fetal sex potentially acting as effect modifiers in this association.

Objective:To assess the clinical outcomes of dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 52 patients with Schatzker type IV trans-midline tibial plateau fractures admitted to First Affiliated Hospital to Nanjing Medical University from January 2014 to August 2023, including 37 males and 15 females, aged 19-68 years [(42.3±14.0)years]. All the patients were treated with the surgical scheme of anterior and medial dual-approach bicondylar internal fixation under adjustable positioning. The operation duration, intraoperative blood loss, and fracture healing time were counted. X-ray films were reviewed at 2 days after surgery for residual knee subluxation. At 2 days, 3 and 6 months after surgery, and at the last follow-up, the tibial plateau angle (TPA) and posterior slope angle (PA) were measured with follow-up X-ray films to evaluate whether there was loss of reduction. The knee function was evaluated with the American Hospital for Special Surgery (HSS) knee function score at 3 and 6 months after surgery and at the last follow-up. The anterior posterior displacement and rotation stability of the knee were evaluated with Lachman test and pivot-shift test at the last follow-up. The postoperative complications were recorded.Results:All the patients were followed up for 12-118 months [70(46, 85)months]. The operation duration was 100-180 minutes [145(120, 160)minutes], with intraoperative blood loss of 100-550 ml [(323.8±135.1)ml]. Fractures were healed well in all the patients, with the healing time of 2-4 months [3.0(2.4, 3.5)months]. None of the patients had residual subluxation by X-ray films at 2 days after surgery. There were no significant differences in TPA or PA at each time point after surgery ( P>0.05). The HSS knee function score was (69.4±4.9)points, (80.9±7.0)points, and (90.1±7.9)points at 3 and 6 months after surgery and at the last follow-up, respectively and the score gradually increased with the passage of time ( P<0.05). At the last follow-up, all the patients were negative in Lachman test and pivot-shift test. Three patients developed fat liquefaction around medial wounds after surgery, which were healed after dressing change. While the wounds were healed by first intention in the other patients. Postoperative complications such as knee instability, implant loosening, fracture or refracture not occurred. Conclusion:Dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures has the advantages including high fracture healing rate, precise fracture reduction and fixation, satisfactory postoperative functional recovery and fewer complications, without increasing operation duration or intraoperative blood loss.

To investigate the effect of Xuebijing injection (XBJ) on cGAS/STING pathway in alleviating sepsis-induced acute lung injury (ALI), the mouse sepsis-induced ALI model was established by cecal ligation and puncture (CLP), and the cell inflammation model was constructed by LPS stimulating RAW264.7 cells. The effects of XBJ on lung tissue injury and cGAS/STING pathway-related protein expression in septic mice were investigated by HE staining, ELISA, and Western blot. The results showed that XBJ intervention could alleviate lung tissue injury, reduce serum IL-6, TNF-α, IFN-β, IL-1-β levels, and the expression of cGAS, STING, p-TBK1, and p-IRF3 proteins in lung tissue in vivo, and reduce the mRNA level of related inflammatory factors in RAW264.7 cells and the expression of cGAS/STING pathway proteins in vitro. The results showed that XBJ could play a role in the prevention and treatment of sepsis-induced ALI by inhibiting the inflammatory response via inhibition of the activation of cGAS/STING pathway. This study provides a new molecular mechanism for the clinical prevention and treatment of sepsis-induced acute lung injury with XBJ.

Objective:To assess the clinical outcomes of dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 52 patients with Schatzker type IV trans-midline tibial plateau fractures admitted to First Affiliated Hospital to Nanjing Medical University from January 2014 to August 2023, including 37 males and 15 females, aged 19-68 years [(42.3±14.0)years]. All the patients were treated with the surgical scheme of anterior and medial dual-approach bicondylar internal fixation under adjustable positioning. The operation duration, intraoperative blood loss, and fracture healing time were counted. X-ray films were reviewed at 2 days after surgery for residual knee subluxation. At 2 days, 3 and 6 months after surgery, and at the last follow-up, the tibial plateau angle (TPA) and posterior slope angle (PA) were measured with follow-up X-ray films to evaluate whether there was loss of reduction. The knee function was evaluated with the American Hospital for Special Surgery (HSS) knee function score at 3 and 6 months after surgery and at the last follow-up. The anterior posterior displacement and rotation stability of the knee were evaluated with Lachman test and pivot-shift test at the last follow-up. The postoperative complications were recorded.Results:All the patients were followed up for 12-118 months [70(46, 85)months]. The operation duration was 100-180 minutes [145(120, 160)minutes], with intraoperative blood loss of 100-550 ml [(323.8±135.1)ml]. Fractures were healed well in all the patients, with the healing time of 2-4 months [3.0(2.4, 3.5)months]. None of the patients had residual subluxation by X-ray films at 2 days after surgery. There were no significant differences in TPA or PA at each time point after surgery ( P>0.05). The HSS knee function score was (69.4±4.9)points, (80.9±7.0)points, and (90.1±7.9)points at 3 and 6 months after surgery and at the last follow-up, respectively and the score gradually increased with the passage of time ( P<0.05). At the last follow-up, all the patients were negative in Lachman test and pivot-shift test. Three patients developed fat liquefaction around medial wounds after surgery, which were healed after dressing change. While the wounds were healed by first intention in the other patients. Postoperative complications such as knee instability, implant loosening, fracture or refracture not occurred. Conclusion:Dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures has the advantages including high fracture healing rate, precise fracture reduction and fixation, satisfactory postoperative functional recovery and fewer complications, without increasing operation duration or intraoperative blood loss.

Bisphenols are widely used in the manufacture of polycarbonates and plastics. With the restriction and banning of bisphenol A (BPA), a typical representative of bisphenols, bisphenol S (BPS) has been widely used in the manufacture of various polymers as the main alternative to BPA. Humans are exposed to BPS through a variety of routes, and BPS is detected in food, environment, and human blood and excreta. Concerns about the safety of BPS have become an important issue, especially for pregnant women and fetuses. The results of several studies support that prenatal exposure to BPS have multiple adverse effects on the offspring. In particular, prenatal BPS exposure may affect maternal and offspring metabolic homeostasis and increase the risk of abnormal lipid metabolism in the offspring. This paper summarized the results of studies on BPS exposure and abnormal lipid metabolism. In addition, this review explored potential mechanisms of BPS, including its possible influence on lipid metabolism through interference with hormone receptors, activation of the nuclear receptor peroxisome proliferator-activated receptor γ (PPARγ), induction of oxidative stress and inflammatory states, and epigenetic effects. These findings emphasized the importance of more in-depth research on BPS and its potential effects to better understand its impact on human health and to provide a basis for developing appropriate public health measures to reduce the risk of BPS exposure.

Objective:To evaluate the iliofemoral approach and its modified approaches in the treatment of acetabular fractures involving the roof column and roof wall.Methods:A retrospective study was conducted to analyze the data of 19 patients who had been admitted to Department of Orthopaedics, The First Hospital Affiliated to Nanjing Medical University for acetabular fractures involving the roof column and roof wall from June 2015 to July 2023. There were 12 males and 7 females with an age of (53.5±15.6) years. By the three-column classification for the acetabular fractures, there were 2 cases of type A, 7 cases of type B, and 10 cases of type C. The time from injury to surgery was 6(5, 11) days. All patients underwent surgery through the iliofemoral approach or its modified approaches (the iliofemoral approach in 2 cases, the modified iliofemoral two-window approach in 13 cases, and the modified expanded iliofemoral two-window approach in 4 cases). All patients were fixated with plates and screws after reduction. The surgical time, intraoperative bleeding, complications, quality of fracture reduction, and hip joint function of the affected side were analyzed.Results:For all the 19 patients, the surgical time averaged (186.8±81.3) minutes, and the intraoperative bleeding volume 500(400, 600) mL. After acetabular fracture surgery, anatomical reduction was achieved in 13 cases and satisfactory reduction in 6 cases. The follow-up period for the 19 patients was (42.6±25.9) months. All acetabular fractures achieved bony union after a post-surgery duration of 14(12, 16) weeks. By the modified Merle d'Aubigné & Poster scoring system, the hip function was evaluated at the last follow-up as excellent in 4 cases, as good in 14 cases, and as fair in 1 case. Follow-ups revealed injury to the lateral femoral cutaneous nerve after surgery in 11 patients, of whom 5 were fully recovered and 6 partially recovered after treatment. Ectopic ossification developed after surgery in 3 patients, of whom 1 was rated as Brooker grade Ⅰ and 2 were as Brooker grade Ⅱ.Conclusion:In the treatment of acetabular fractures involving the roof column and roof wall, fixation with plates and screws through the iliofemoral approach or its modified approaches may achieve fine clinical outcomes in addition to the advantages of operative convenience and high safety.

Objective:To evaluate the iliofemoral approach and its modified approaches in the treatment of acetabular fractures involving the roof column and roof wall.Methods:A retrospective study was conducted to analyze the data of 19 patients who had been admitted to Department of Orthopaedics, The First Hospital Affiliated to Nanjing Medical University for acetabular fractures involving the roof column and roof wall from June 2015 to July 2023. There were 12 males and 7 females with an age of (53.5±15.6) years. By the three-column classification for the acetabular fractures, there were 2 cases of type A, 7 cases of type B, and 10 cases of type C. The time from injury to surgery was 6(5, 11) days. All patients underwent surgery through the iliofemoral approach or its modified approaches (the iliofemoral approach in 2 cases, the modified iliofemoral two-window approach in 13 cases, and the modified expanded iliofemoral two-window approach in 4 cases). All patients were fixated with plates and screws after reduction. The surgical time, intraoperative bleeding, complications, quality of fracture reduction, and hip joint function of the affected side were analyzed.Results:For all the 19 patients, the surgical time averaged (186.8±81.3) minutes, and the intraoperative bleeding volume 500(400, 600) mL. After acetabular fracture surgery, anatomical reduction was achieved in 13 cases and satisfactory reduction in 6 cases. The follow-up period for the 19 patients was (42.6±25.9) months. All acetabular fractures achieved bony union after a post-surgery duration of 14(12, 16) weeks. By the modified Merle d'Aubigné & Poster scoring system, the hip function was evaluated at the last follow-up as excellent in 4 cases, as good in 14 cases, and as fair in 1 case. Follow-ups revealed injury to the lateral femoral cutaneous nerve after surgery in 11 patients, of whom 5 were fully recovered and 6 partially recovered after treatment. Ectopic ossification developed after surgery in 3 patients, of whom 1 was rated as Brooker grade Ⅰ and 2 were as Brooker grade Ⅱ.Conclusion:In the treatment of acetabular fractures involving the roof column and roof wall, fixation with plates and screws through the iliofemoral approach or its modified approaches may achieve fine clinical outcomes in addition to the advantages of operative convenience and high safety.

Objective:To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model, and to evaluate the clinical application of this model.Methods:A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results:A total of 140 children were enrolled in this study, including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h( OR=6.650, 95% CI 2.469-17.912, P<0.05), abdominal muscle tension( OR=3.082, 95% CI 1.190-7.979, P<0.05) and C-reactive protein>41 mg/L ( OR=3.287, 95% CI 1.274-8.480, P<0.05) were independent risk factors for CA( P<0.05). The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95% CI 0.825-0.936), the sensitivity was 77.4%, the specificity was 87.5%, the positive predictive value was 91.3% and the negative predictive value was 70.0%. Conclusion:Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h, the level of C-reactive protein is increased, and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency, which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.

Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.

Objective:To provide anatomic data of the coracoclavicular (CC) ligament attachment regions in Chinese population for anatomic reconstruction of CC ligament to treat acromioclavicular dislocation.Methods:The CC ligaments were first dissected layer by layer out of the bilateral acromioclavicular joint specimens taken from 87 adult cadavers. The CC width and thickness on the attachments of the clavicle and the coracoid process were measured by an electronic digital caliper. The conoid ligament and trapezoid ligament were mapped on the surface of the clavicle and the coracoid process by transecting the ligaments close to their insertions. The distances from the ligament footprint center to the lateral, anterior and posterior margins of the clavicle were measured. The distances from the ligament footprint center to the tip, medial and lateral margin borders of the coracoid process were measured.Results:The distances from the lateral edge of the clavicle to the footprint centers of the conoid and trapezoid ligaments were (35.7 ± 3.4) mm and (21.8 ± 2.7) mm, and the ratio of the distance divided by the clavicular length was 25.5% ± 0.9% and 15.6% ± 1.1%, respectively. The distances from the tip of coracoid to the footprint centers of the conoid and trapezoid ligaments were (35.1 ± 3.2) mm and (29.7 ± 2.9) mm, and the ratio of the distances divided by the coracoidal length was 86.7% ± 1.9% and 73.3% ± 2.1%, respectively.Conclusion:Although the absolute position of the CC ligament attaching to the clavicle and the coracoid process varies greatly among Chinese individuals, the ratio of its relative position to the length and width of the clavicle and the coracoid process is a relatively stable set of data.