OBJECTIVE To understand the drug resistance among the acquired immune deficiency syndrome(AIDS)population who failed in the antiviral therapy from 2022 to 2023 and analyze the molecular network.METHODS The plasma specimens were collected from the population with viral load no less than 1000 cps/ml who received antiviral therapy for more than 6 months in Aksu area from 2022 to 2023,which were delivered to Aksu Regional Center for Disease Control and Prevention for test.MEGA5 and the Stanford University drug resistance database were employed to determine the subtypes and drug resistance after the sequences of human immunodefi-ciency virus type Ⅰ polymerase gene region(HIV-1pol)were obtained,and the molecular network was established by HIV-trace.RESULTS Totally 648 sequences of HIV-1pol region were obtained,CRF07_BC(97.69％)was the major subtype,and the drug resistance rate was 58.33％;the drug resistance rates to non-nucleoside reverse transcriptase inhibitor(NNRTI),nucleoside reverse transcriptase inhibitor(NRTI)and protease inhibitor(PI)were 51.70％,19.75％and8.64％,respectively.The univariate analysis showed that year(x2=6.341),age(x2=18.455)and route of infection(x2=14.061)had remarkable effects on the drug resistance among the population with failed ART(P＜0.05).Multivariate regression analysis indicated that the drug resistance rate was higher in 2022 than in 2023(95％CI:1.132 to 2.191),and the drug resistance rate was higher among the population aged less than 60 years old than among the population more than 6 years old(95％CI:3.647 to 70.268,95％CI:1.435 to 8.235,95％CI:1.061 to 6.164,re-spectively).With 1.5％of the genetic distance set as the threshold,the molecular network was established,the network access rate was 49.07％,77.14％of the clusters had drug-resistant mutation sites,and the male population was at higher risk of network access than the female population.CONCLUSIONS The drug resistance rate is relatively high among the AIDS population with failed ART,and the drug-resistant strains appear in clusters in the molecular network.It is neces-sary to further strengthen the monitoring of drug resistance and improve the quality of the follow-up so as to reduce the occurrence of drug resistance and transmission of virulent strains.

Objective:To explore the clinical value of the three-dimensional fat suppression fast spoiled gradient echo (3D-FS-FSPGR) MRI sequence in the preoperative evaluation of congenital radial polydactyly.Methods:The data of children with congenital radial polydactyly who underwent surgical treatment in the Department of Orthopedics at Shanxi Children’s Hospital from May 2021 to April 2022 were retrospectively analyzed. Preoperative X-ray examinations and MRI 3D-FS-FSPGR sequence scans were performed on the children. Radiologists first described the morphological characteristics of the articular cartilage, and then orthopedic surgeons performed the Wassel classification based on the X-ray and MRI imaging result, focusing on the bifurcation level, morphology, and articular surface of the phalangeal and metacarpal cartilage. The corresponding surgical method was selected according to the Wassel classification, and intraoperative incision exploration was used as the gold standard. Six months after surgery, the surgical outcome was evaluated using the modified Tada scoring system [with a total score of 0-7, and classified as excellent: >5 points, good: 3-5 points, and poor: <3 points; the excellent and good rate = (excellent + good) cases/total number of cases × 100%]. The appearance, function and recurrence of the operated finger were evaluated 1 year after surgery. Descriptive statistics were performed using SPSS 26.0 software, and the Kappa coefficient was used to evaluate the consistency of the Wassel classification result between radiographs, MRI 3D-FS-FSPGR sequences and intraoperative exploration respectively.Results:A total of 45 children (55 fingers) with congenital radial polydactyly were enrolled, including 25 males and 20 females, aged 5 to 60 months, with the median age of 9 months. Unilateral findings were seen in 35 cases and bilateral findings in 10 cases. MRI 3D-FS-FSPGR imaging sequences clearly demonstrated the level of cartilage bifurcation and bone tissue growth and development, which were consistent with intraoperative exploration findings. The accuracy of the MRI 3D-FS-FSPGR Wassel classification was 100% (55/55), and the accuracy of the X-ray Wassel classification was 81.8% (45/55). Disagreements were found in the classifications of five fingers: three with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅲ, and two with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅴ. The Kappa coefficients were all >0.85. All patients were followed up for 1 year. The modified Tada score showed excellent in 41 fingers, good in 6 fingers, and poor in 8 fingers, for an excellent and good rate of 85.5% (47/55). At final follow-up, the reconstructed thumbs showed significant improvement in appearance, with normal bone axis restoration, no deviation of the digits, and normal nail appearance. There was no significant scarring or contracture. Functions of thumb flexion, extension, grasping, and opposition were good. There was no postoperative deformity or recurrence.Conclusion:MRI 3D-FS-FSPGR sequences can accurately classify congenital radial polydactyly preoperatively, optimize the surgical incision and osteotomy alignment, and achieve excellent surgical outcomes.

OBJECTIVE To understand the drug resistance among the acquired immune deficiency syndrome(AIDS)population who failed in the antiviral therapy from 2022 to 2023 and analyze the molecular network.METHODS The plasma specimens were collected from the population with viral load no less than 1000 cps/ml who received antiviral therapy for more than 6 months in Aksu area from 2022 to 2023,which were delivered to Aksu Regional Center for Disease Control and Prevention for test.MEGA5 and the Stanford University drug resistance database were employed to determine the subtypes and drug resistance after the sequences of human immunodefi-ciency virus type Ⅰ polymerase gene region(HIV-1pol)were obtained,and the molecular network was established by HIV-trace.RESULTS Totally 648 sequences of HIV-1pol region were obtained,CRF07_BC(97.69％)was the major subtype,and the drug resistance rate was 58.33％;the drug resistance rates to non-nucleoside reverse transcriptase inhibitor(NNRTI),nucleoside reverse transcriptase inhibitor(NRTI)and protease inhibitor(PI)were 51.70％,19.75％and8.64％,respectively.The univariate analysis showed that year(x2=6.341),age(x2=18.455)and route of infection(x2=14.061)had remarkable effects on the drug resistance among the population with failed ART(P＜0.05).Multivariate regression analysis indicated that the drug resistance rate was higher in 2022 than in 2023(95％CI:1.132 to 2.191),and the drug resistance rate was higher among the population aged less than 60 years old than among the population more than 6 years old(95％CI:3.647 to 70.268,95％CI:1.435 to 8.235,95％CI:1.061 to 6.164,re-spectively).With 1.5％of the genetic distance set as the threshold,the molecular network was established,the network access rate was 49.07％,77.14％of the clusters had drug-resistant mutation sites,and the male population was at higher risk of network access than the female population.CONCLUSIONS The drug resistance rate is relatively high among the AIDS population with failed ART,and the drug-resistant strains appear in clusters in the molecular network.It is neces-sary to further strengthen the monitoring of drug resistance and improve the quality of the follow-up so as to reduce the occurrence of drug resistance and transmission of virulent strains.

Recent innovations in endoscopic techniques have dramatically transformed the landscape of biliary and pancreatic disease management,particularly through the synergistic integration of peroral choledochoscope-assisted cholangioscopy and endoscopic retrograde cholangiopancreatography(ERCP).This article delves into the clinical utility of peroral choledochoscope within the ERCP framework,highlighting its pivotal role in enhancing diagnostic precision.

Recent innovations in endoscopic techniques have dramatically transformed the landscape of biliary and pancreatic disease management,particularly through the synergistic integration of peroral choledochoscope-assisted cholangioscopy and endoscopic retrograde cholangiopancreatography(ERCP).This article delves into the clinical utility of peroral choledochoscope within the ERCP framework,highlighting its pivotal role in enhancing diagnostic precision.

Objective:To investigate protective effect and mechanism of Tim-3 on sepsis-induced acute lung injury(ALI)by pro-moting mitophagy of alveolar macrophages and inhibiting activation of NLRP3 inflammasome.Methods:LPS-stimulated mouse alveo-lar macrophage(MH-S)model and sepsis-induced ALI mouse model were constructed.Tim-3 siRNA interference technique was used to knock down Tim-3 expression in MH-S cells,and anti-Tim-3 antibody mice were injected intraperitoneally to block Tim-3 function.Western blot was used to detect protein expressions of NLRP3,ASC,cleaved-caspase-1 and mitophagy-related proteins(LC3B,P62,PINK1 and Parkin)in MH-S cells and lung tissue of mice with sepsis-induced ALI.Laser confocal fluorescence staining was used to measure ROS level and mitochondrial membrane potential of MH-S cells.Pathological examination of lung tissue was performed in mice with sepsis-induced ALI in each group,and degree of lung tissue injury was evaluated by Smith scoring system.Bronchoalveolar lavage fluid(BALF)and lung tissue were collected from mice with ALI induced by sepsis in each group.BCA protein quantification method was used to determine protein concentration in BALF.MPO activity in lung tissue was detected by colorimetry.MDA content in lung tissue was detected by TBA method.LC3B protein expression in lung tissue was detected by immunohistochemistry.Results:In mouse alveolar macrophages,Tim-3 knockdown could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins,increase ROS release,inhibit PINK1/Parkin pathway activation and LC3B protein expression,and reduce mitochondrial membrane potential.In mice with sepsis-induced ALI,Tim-3 functional blockade could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins in lung tissue,aggravate lung pathological injury and pulmonary edema,increase MPO activity and MDA content in lung tissue,and reduce positive rate of LC3B protein.Conclusion:Tim-3 plays a protective role in sepsis-induced ALI by promoting mitophagy in alveolar macrophages and inhibiting NLRP3 inflammasome activation via PINK1/Parkin.

Objective:To investigate protective effect and mechanism of Tim-3 on sepsis-induced acute lung injury(ALI)by pro-moting mitophagy of alveolar macrophages and inhibiting activation of NLRP3 inflammasome.Methods:LPS-stimulated mouse alveo-lar macrophage(MH-S)model and sepsis-induced ALI mouse model were constructed.Tim-3 siRNA interference technique was used to knock down Tim-3 expression in MH-S cells,and anti-Tim-3 antibody mice were injected intraperitoneally to block Tim-3 function.Western blot was used to detect protein expressions of NLRP3,ASC,cleaved-caspase-1 and mitophagy-related proteins(LC3B,P62,PINK1 and Parkin)in MH-S cells and lung tissue of mice with sepsis-induced ALI.Laser confocal fluorescence staining was used to measure ROS level and mitochondrial membrane potential of MH-S cells.Pathological examination of lung tissue was performed in mice with sepsis-induced ALI in each group,and degree of lung tissue injury was evaluated by Smith scoring system.Bronchoalveolar lavage fluid(BALF)and lung tissue were collected from mice with ALI induced by sepsis in each group.BCA protein quantification method was used to determine protein concentration in BALF.MPO activity in lung tissue was detected by colorimetry.MDA content in lung tissue was detected by TBA method.LC3B protein expression in lung tissue was detected by immunohistochemistry.Results:In mouse alveolar macrophages,Tim-3 knockdown could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins,increase ROS release,inhibit PINK1/Parkin pathway activation and LC3B protein expression,and reduce mitochondrial membrane potential.In mice with sepsis-induced ALI,Tim-3 functional blockade could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins in lung tissue,aggravate lung pathological injury and pulmonary edema,increase MPO activity and MDA content in lung tissue,and reduce positive rate of LC3B protein.Conclusion:Tim-3 plays a protective role in sepsis-induced ALI by promoting mitophagy in alveolar macrophages and inhibiting NLRP3 inflammasome activation via PINK1/Parkin.

Objective:To investigate the relationship of the levels of 25-hydroxyvitamin (OH) D, monocyte chemoattractant protein-1 (MCP-1) and bone mineral density (BMD) and bone metabolism in preschool children after fractures.Methods:General data of 200 preschool children with fractures admitted to the Department of Orthopedics of Shanxi Children’s Hospital from Apr. 2021 to Jun. 2024 were retrospectively analyzed. The 25- (OH) D level of the children after fracture was determined by electrochemical luminescence method. According to the 25- (OH) D level, the children were divided into VitD deficiency group, VitD insufficient group and VitD sufficient group. The MCP-1 level, BMD and bone metabolism indexes of children among groups were compared and analyzed. SPSS 26.0 statistical software was used to analyze the data in the paper. According to the data type, t test or χ2 test were used to compare among the groups, and the correlation of 25- (OH) D and MCP-1 levels with BMD and bone metabolism indexes was analyzed by Spearman and Pearson methods. Results:The difference of 25- (OH) D levels in different age childeren was statistically significant ( t = 145.26, P<0.05) , and the analysis showed that 26 cases were VitD deficient, 64 cases were VitD insufficient, and 110 cases were VitD sufficient; The mean BMD in VitD patients with different levels was significantly different ( F=783.25, P<0.05) ; With the increase of MCP-1, PTH and TPINP levels decreased ( F=78.98, 703.57, 243.27, P<0.05) , while the levels of PICP and BGP increased ( F=122.97, 340.32, P<0.05) ; 25- (OH) D was positively correlated with BMD, PICP and BGP ( r=0.93, 0.76, 0.87, P<0.05) , and negatively correlated with PTH and TPINP ( r=-0.94, -0.81, P<0.05) . MCP-1 was negatively correlated with BMD, PICP and BGP ( r=-0.54, -0.51, -0.56, P<0.05) , and positively correlated with PTH and TPINP ( r=0.57, 0.55, P<0.05) . Conclusions:The 25- (OH) D level is significantly correlated with BMD and bone metabolism indexes in preschool children after fracture, and the lack and insufficiency of VitD significantly affect BMD and bone metabolism status. At the same time, MCP-1 may also play an important role in metabolic changes after fracture. Therefore, in clinical treatment, it is necessary to strengthen the monitoring and management of 25- (OH) D and MCP-1 levels after fracture in children, which is of great significance to promote bone healing and improve bone density.

Objective:To investigate the relationship of the levels of 25-hydroxyvitamin (OH) D, monocyte chemoattractant protein-1 (MCP-1) and bone mineral density (BMD) and bone metabolism in preschool children after fractures.Methods:General data of 200 preschool children with fractures admitted to the Department of Orthopedics of Shanxi Children’s Hospital from Apr. 2021 to Jun. 2024 were retrospectively analyzed. The 25- (OH) D level of the children after fracture was determined by electrochemical luminescence method. According to the 25- (OH) D level, the children were divided into VitD deficiency group, VitD insufficient group and VitD sufficient group. The MCP-1 level, BMD and bone metabolism indexes of children among groups were compared and analyzed. SPSS 26.0 statistical software was used to analyze the data in the paper. According to the data type, t test or χ2 test were used to compare among the groups, and the correlation of 25- (OH) D and MCP-1 levels with BMD and bone metabolism indexes was analyzed by Spearman and Pearson methods. Results:The difference of 25- (OH) D levels in different age childeren was statistically significant ( t = 145.26, P<0.05) , and the analysis showed that 26 cases were VitD deficient, 64 cases were VitD insufficient, and 110 cases were VitD sufficient; The mean BMD in VitD patients with different levels was significantly different ( F=783.25, P<0.05) ; With the increase of MCP-1, PTH and TPINP levels decreased ( F=78.98, 703.57, 243.27, P<0.05) , while the levels of PICP and BGP increased ( F=122.97, 340.32, P<0.05) ; 25- (OH) D was positively correlated with BMD, PICP and BGP ( r=0.93, 0.76, 0.87, P<0.05) , and negatively correlated with PTH and TPINP ( r=-0.94, -0.81, P<0.05) . MCP-1 was negatively correlated with BMD, PICP and BGP ( r=-0.54, -0.51, -0.56, P<0.05) , and positively correlated with PTH and TPINP ( r=0.57, 0.55, P<0.05) . Conclusions:The 25- (OH) D level is significantly correlated with BMD and bone metabolism indexes in preschool children after fracture, and the lack and insufficiency of VitD significantly affect BMD and bone metabolism status. At the same time, MCP-1 may also play an important role in metabolic changes after fracture. Therefore, in clinical treatment, it is necessary to strengthen the monitoring and management of 25- (OH) D and MCP-1 levels after fracture in children, which is of great significance to promote bone healing and improve bone density.

Hepatocellular carcinoma (HCC) stands as the predominant type of primary liver cancer, frequently accompanied by portal vein tumor thrombosis (PVTT). PVTT is a harbinger of a grim prognosis, with current treatment modalities falling short of expectations. Delving deeper into the pathophysiology of PVTT, researchers have come to recognize that PVTT and HCC may originate from different clones. Previous clinical investigations have proposed various PVTT classification systems, offering a scientific basis for individualized and precise treatment. The innovative surgical approach of “thrombectomy first” is designed to mitigate the risk of tumor spread, thereby enhancing patient outcomes. Moreover, the multidisciplinary and integrated treatment model, including targeted therapy, immunotherapy and radiotherapy, has demonstrated promising efficacy for the treatment of PVTT. With the continuous progress and optimization of PVTT diagnostic technology, classification systems and precision treatment strategies, the prospects for long-term survival in HCC patients with PVTT are poised to see a significant uplift.