Objective:To evaluate the association between heatwaves and fall-related mortality.Methods:A total of 61 421 fall-related mortality from 2013 to 2022 in 7 provinces of China were included in a time-stratified case-crossover design, with daily meteorological data derived from the fifth generation European Reanalysis dataset produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression chimeric distributed lag nonlinear model was used to analyze the association between heatwaves and fall-related mortality and stratified analysis was conducted according to gender and age.Results:Heatwaves were associated with an increased risk of fall-related morality. The risk of fall-related mortality during heatwaves was higher than during non-heatwave periods ( OR=1.11, 95% CI: 1.05-1.18). The attributable fraction of fall-related motality due to heatwaves was 10.25% (95% CI: 4.49%-15.36%). For each 1 ℃ increase above the heatwave threshold, the risk of fall-related mortality increased by 34% ( OR=1.34, 95% CI: 1.02-1.76). The effect of heatwave duration on fall-related mortality was not statistically significant. Stratified analyses indicated that women experienced a higher risk of fall-related mortality during heatwaves ( OR=1.13, 95% CI: 1.04-1.22) compared to man ( OR=1.10, 95% CI: 1.04-1.17). Conclusions:Heatwave increases the risk of fall-related mortality, and the intensity of heatwaves modify this risk. Women are vulnerable populations.

BACKGROUND:Ilizarov bone transport is very effective in the treatment of open large tibial bone defects,but there are still complications,among which the difficulty of junction healing is one of the difficult points in treatment. OBJECTIVE:To investigate the effect of Ilizarov bone transport combined with antibiotic bone cement on junction healing after operation of open large tibial bone defect. METHODS:Totally 51 patients with open large tibial bone defect(bone defect>4 cm)admitted to Binzhou Medical University Hospital from August 2010 to January 2022 were selected,of which 28 received Ilizarov bone transport alone(control group)and 23 received Ilizarov bone transport combined with antibiotic bone cement treatment(trial group).External fixation time,bone healing time,bone healing index,visual analog scale score during bone removal,bone defect limb function,junction healing and complications at the final follow-up were statistically compared between the two groups. RESULTS AND CONCLUSION:(1)All the 51 patients were followed up for a mean of(22.53±5.77)months.External fixation time,bone healing time,bone healing index,postoperative infection rate,and non-healing rate of junction were less in the trial group than those in the control group(P<0.05).There was no significant difference between the two groups in visual analog scale scores at 6 months after the second surgery and in the functional excellence and good rate of limb with bone defect at the final follow-up(P>0.05).(2)These findings indicate that compared with the Ilizarov bone transport alone,Ilizarov bone transport combined with antibiotic bone cement treatment can promote the healing of open tibial fracture junction and increase the rate of bone healing.

Objective:To evaluate the association between heatwaves and fall-related mortality.Methods:A total of 61 421 fall-related mortality from 2013 to 2022 in 7 provinces of China were included in a time-stratified case-crossover design, with daily meteorological data derived from the fifth generation European Reanalysis dataset produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression chimeric distributed lag nonlinear model was used to analyze the association between heatwaves and fall-related mortality and stratified analysis was conducted according to gender and age.Results:Heatwaves were associated with an increased risk of fall-related morality. The risk of fall-related mortality during heatwaves was higher than during non-heatwave periods ( OR=1.11, 95% CI: 1.05-1.18). The attributable fraction of fall-related motality due to heatwaves was 10.25% (95% CI: 4.49%-15.36%). For each 1 ℃ increase above the heatwave threshold, the risk of fall-related mortality increased by 34% ( OR=1.34, 95% CI: 1.02-1.76). The effect of heatwave duration on fall-related mortality was not statistically significant. Stratified analyses indicated that women experienced a higher risk of fall-related mortality during heatwaves ( OR=1.13, 95% CI: 1.04-1.22) compared to man ( OR=1.10, 95% CI: 1.04-1.17). Conclusions:Heatwave increases the risk of fall-related mortality, and the intensity of heatwaves modify this risk. Women are vulnerable populations.

Objective To explore the clinical results after arthroscopy-assisted anatomic coracoclavicu-lar ligament reconstruction(AA-ACCR)using tendon allograft for acute high-grade acromioclavicular joint dislocations.Methods Patients undergoing primary AA-ACCR with tendon allograft for Rockwood type Ⅲ/Ⅴ acromioclavicular joint dislocations between January 2015 and January 2017 were analyzed retrospectively.The coracoclavicular distance(CCD)was obtained on radiographs pre-and post-opera-tively,as well as 6 weeks after the operation and during the final follow-up,and complications were recorded.Moreover,before the operation and during the final follow-up,all patients were evaluated shoulder pain and function using the American Shoulder and Elbow Surgeon score(ASES)and Visual Analogue Scale(VAS).Results In total,21 patients were included for evaluation with a minimum of 6-month follow-up(range,6-18 months).According to preoperative X ray,8 and 13 patients suffered from Rockwood type Ⅲ and V acromioclavicular dislocation,respectively.CCD decreased significantly six weeks postoperatively(8.6±2.6 mm)and at the final follow-up(11.7±3.5 mm)compared with the preoperative value(19.7±4.5 mm,P＜0.01).However,CCD at the latter time points was signifi-cantly higher than right after the operation(7.9±2.5 mm,P＜0.01).Furthermore,CCD increased sig-nificantly at the final follow-up compared with six weeks postoperatively(P＜0.01).At the final follow-up,significant improvement was observed in the average VAS and ASES scores(P＜0.01).Moreover,at the final follow-up,10 out of 21 patients(48％)experienced a loss of reduction,including 3 fail-ures in operation and 7 in later restoration.All patients had both medial and lateral clavicular tunnel widening.However,no fracture of the coracoid/clavicle or other complications were recorded.Conclu-sion AA-ACCR with tendon allograft for acute high-grade acromioclavicular joint dislocations contrib-utes to significant improvement in clinical and radiographic outcomes in the early follow-up.Although the loss of reduction rate is relatively high(48％),it is a safe method without obvious complications.

Purpose: This study aims to evaluate the efficacy and safety of a new combination treatment of vinorelbine and pyrotinib in human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (MBC) and provide higher level evidence for clinical practice. Materials and Methods: This was a prospective, single-arm, phase 2 trial conducted at three institutions in China. Patients with HER2-positive MBC, who had previously been treated with trastuzumab plus a taxane or trastuzumab plus pertuzumab combined with a chemotherapeutic agent, were enrolled between March 2020 and December 2021. All patients received pyrotinib 400 mg orally once daily plus vinorelbine 25 mg/m2 intravenously or 60-80 mg/m2 orally on day 1 and day 8 of 21-day cycle. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included the objective response rate (ORR), disease control rate (DCR), overall survival, and safety. Results: A total of 39 patients were enrolled. All patients had been pretreated with trastuzumab and 23.1% (n=9) of them had accepted trastuzumab plus pertuzumab. The median follow-up time was 16.3 months (95% confidence interval [CI], 5.3 to 27.2), and the median PFS was 6.4 months (95% CI, 4.0 to 8.8). The ORR was 43.6% (95% CI, 27.8% to 60.4%) and the DCR was 84.6% (95% CI, 69.5% to 94.1%). The median PFS of patients with versus without prior pertuzumab treatment was 4.6 and 8.3 months (p=0.017). The most common grade 3/4 adverse events were diarrhea (28.2%), neutrophil count decreased (15.4%), white blood cell count decreased (7.7%), vomiting (5.1%), and anemia (2.6%). Conclusion Pyrotinib plus vinorelbine showed promising efficacy and tolerable toxicity as second-line treatment in patients with HER2-positive MBC.

Objective To explore the clinical results after arthroscopy-assisted anatomic coracoclavicu-lar ligament reconstruction(AA-ACCR)using tendon allograft for acute high-grade acromioclavicular joint dislocations.Methods Patients undergoing primary AA-ACCR with tendon allograft for Rockwood type Ⅲ/Ⅴ acromioclavicular joint dislocations between January 2015 and January 2017 were analyzed retrospectively.The coracoclavicular distance(CCD)was obtained on radiographs pre-and post-opera-tively,as well as 6 weeks after the operation and during the final follow-up,and complications were recorded.Moreover,before the operation and during the final follow-up,all patients were evaluated shoulder pain and function using the American Shoulder and Elbow Surgeon score(ASES)and Visual Analogue Scale(VAS).Results In total,21 patients were included for evaluation with a minimum of 6-month follow-up(range,6-18 months).According to preoperative X ray,8 and 13 patients suffered from Rockwood type Ⅲ and V acromioclavicular dislocation,respectively.CCD decreased significantly six weeks postoperatively(8.6±2.6 mm)and at the final follow-up(11.7±3.5 mm)compared with the preoperative value(19.7±4.5 mm,P＜0.01).However,CCD at the latter time points was signifi-cantly higher than right after the operation(7.9±2.5 mm,P＜0.01).Furthermore,CCD increased sig-nificantly at the final follow-up compared with six weeks postoperatively(P＜0.01).At the final follow-up,significant improvement was observed in the average VAS and ASES scores(P＜0.01).Moreover,at the final follow-up,10 out of 21 patients(48％)experienced a loss of reduction,including 3 fail-ures in operation and 7 in later restoration.All patients had both medial and lateral clavicular tunnel widening.However,no fracture of the coracoid/clavicle or other complications were recorded.Conclu-sion AA-ACCR with tendon allograft for acute high-grade acromioclavicular joint dislocations contrib-utes to significant improvement in clinical and radiographic outcomes in the early follow-up.Although the loss of reduction rate is relatively high(48％),it is a safe method without obvious complications.

Objective:Exploring tau related disease pattern (tauRDP) in the brain of Alzheimer′s disease (AD) patients based on 18F-APN-1607 PET scan. Methods:18F-APN-1607 PET images were collected from 17 AD patients (6 males and 11 females, age: (61.7±12.3) years, Mini-Mental State Examination (MMSE) score: 17.6±7.9) and 10 normal controls (NC; 6 males and 4 females, age: (61.2±4.7) years) from Huashan Hospital of Fudan University. The scaled subprofile model (SSM) based on principal component analysis (PCA) technique was used to construct the tauRDP. Then the expression value of tauRDP in each sample was calculated. The differences on tauRDP expression values between AD patients and NC were compared by independent-sample t test. Pearson correlation analysis was used to analyze the correlation between tauRDP expression values and MMSE values in AD patients. Results:The tauRDP area mainly included: precentral gyrus, dorsolateral superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus of opercular part, inferior frontal gyrus of triangular part, supplementary motor area, medial superior frontal gyrus, left median cingulate and paracingulate gyri, right cuneus, superior occipital gyrus, middle occipital gyrus, postcentral gyrus, superior parietal gyrus inferior parietal, but supramarginal and angular gyri, supramarginal gyrus, angular gyrus, precuneus and middle temporal gyrus. There were significant differences ( t=4.395, P<0.001) between AD group (12.6±8.0) and NC group (0.0±1.0) in tauRDP expression values. The tauRDP expression values were correlated with MMSE values in AD group significantly ( r=-0.566, P=0.018). Conclusions:TauRDP established basing on SSM/PCA method can be used to quantitatively express the abnormal spatial distributions of tau deposition. Expression value of tauRDP has the potential to initially assess the severity of AD.

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture.Methods 203 patients with stage Ⅰ of unstable femoral intertrochanteric fracture were selected as the research object,and they were taken artificial lengthening femoral head replacement,among which 65caese were male,female in 138 cases.The Harris scoring,SF-36,VAS pain scores on admission,2 weeks after operation,postoperative follow-up limb were counted,and the pain of the affected limb and the hip scores were compared amond 3 time periods.Results All 203 cases of senile patients with follow-up,average operation time was 83.64 minutes,the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score,SF-36 and VAS pain scoring criteria,and the Harris scores of the affected limbs at admission,at 2 weeks after the operation and after the follow-up were (28.26 ± 5.50) points,(68.26 ±5.50) points,(93.13 ± 5.31) points,respectively,the differences were statistically significant (t =-71.27,-1 397.55,-46.07,all P ＜ 0.01);The VAS pain scores were (8.19 ± 0.48) points,(3.53 ± 0.71) points,(0.23 ± 0.42) points,respectively,the differences were statistically significant (t =88.06,324.17,60.84,all P ＜ 0.01).The sf-36 scores:physiological [(8.35 ± 1.24) points,(15.23 ± 2.17) points,(19.21 ± 2.12) points],social/family [(7.01 ±1.13) points,(14.12 ± 2.12) points,(19.85 ± 2.24) points],emotional [(4.83 ± 1.01) points,(10.12 ±1.22)points,(14.87 ± 1.32) points],function [(6.35 ± 1.21) points,(13.67 ± 1.87) points,(16.81 ±2.12) points],additional focus [(8.85 ± 1.45) points,(16.38 ± 2.12) points,(20.21 ± 2.42) points],total quality of life [(47.35 ± 4.76) points,(74.69 ± 5.87) points,(89.21 ± 6.12) points],the differences were statistically significant(-39.77,-62.92,-20.21,-44.87,-71.89,-26.79,-45.04,-89.01,-38.25,-45.79,-63.41,-15.29,-45.20,-60.39,-17.54,-52.12,-76.49,-22.58,all P＜0.O1).Conclusion Artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture has good clinical effect,intraoperative high safety,less postoperative complications,postoperative limb functional recovery is good,and it is worthy of clinical promotion and application.

Objective To investigate w hether the iterative reconstruction (iDose 4 ) technique improves imaging quality of the low-radiation-dose w hole brain CT perfusion (CTP). Methods Thirty-five consecutive patients w ith clinical y suspected ischemic stroke w ere col ected. Bril iance 256 iCT w as used to perform low-radiation-dose w hole brain CTP, and the filtered back projection (FBP) and iDose 4 algorithm w ere used to conduct image reconstruction. The noise and signal to noise ratio of the 2 kinds of reconstruction algorithms, as w el as the imaging quality of each parameter map w ere compared. Results The effective dose of the w hole brain CTP w as 2.2 mSv. Compared w ith FBP, the noise of each region of interest in the iDose4 Tmax map was decreased significantly ( P<0.05) and the signal to noise ratio was increased significantly (P<0.05). The imaging quality scores (median, interquartile range) reconstructed by FPB group w ere significantly low er than by iDose 4 for cerebral blood flow (CBF) map ( 5.00 [3.00-6.00]vs. 6.00 [5.00-6.00]; Z= -2.784, P=0.005), cerebral blood volume (CBV) map ( 6.00 [5.00-6.00] vs. 6.00 [6.00-7.00]; Z= -3.674, P<0.001), and mean transit time (MTT) map (4.00 [3.00-5.00] vs. 5.00 [4.00-6.00]; Z=3.394, P=0.001). The proportions of the poor quality in CBF map ( 34.3%vs. 11.4%;χ2 =7.036, P=0.030), CBV map (11.4%vs.2.9%; χ2 =7.485, P=0.024 ) and MTT map (28.6%vs.11.4%;χ2 =5.318, P=0.070) reconstructed by FBP w ere significantly higher than by iDose 4 . Conclusions The iDose4 technique may improve imaging quality of low er-radiation-dose CTP.

Objective To investigate the application value of serum pancreatic isled autoantibodies and biochemical indicators in classification diagnosis of type 1 diabetes mellitus (T1DM ) and type 2 diabetes mellitus (T2DM ) .Methods The clinical data and laboratory detection results in 99 cases of T1DM and 577 cases of T2DM were retrospectively analyzed .The levels of pancreatic isled autoantibodies and biochemical indicators were compared between the two groups and their characteristics were analyzed .Re‐sults The positive rates of single detection and combine detection of glutamic acid decarboxylase autoantibodies (GADA) ,insulino‐ma‐associated antigen‐2 autoantibodies (IA‐2A ) ,islet cell autoantibodies (ICA ) and ZnT8 autoantibodies (ZnT8A ) in the T1DM group were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05) .The onset age ,fasting and postprandial 2 h CP ,fasting and postprandial 2 h insulin(2 h INS) ,triglyceride(TG) and body mass index (BMI) in the T1DM group were lower than those in the T2DM group ,while the levels of fasting and postprandial 2h blood glucose ,glycosylated hemo‐globin(HbA1c) and high‐density lipoprotein cholesterol(HDL‐C) were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05);however total cholesterol and low‐density lipoprotein cholesterol levels had no statistical differ‐ence between the T1DM group and T2DM group (P>0 .05) .Moreover ,the fasting and postprandial 2 h CP levels in the T1DM group showed decreasing trend as the T1DM course extending ,and the difference had statistical difference among different disease courses ;but the fasting and postprandial 2 h CP levels in the T2DM group had no obvious decreasing trend .The areas under the receiver operating characteristic(ROC) curve of fasting and postprandial 2 h CP for differential diagnosis of T1DM and T2DM in the patients with the disease course < 2 year were 0 .902(95% CI:0 .850-0 .954) and 0 .905(95% CI:0 .852-0 .958) respective‐ly .The suitable threshold value of fasting CP was 0 .283 nmol/L ,its sensitivity and specificity were 82 .6% and 89 .2% ,respective‐ly ,which of postprandial 2 h CP was 0 .421 nmol/L ,its sensitivity and specificity were 84 .8% and 89 .2% respectively . Conclusion T1DM and T2DM are different in onset age ,BMI value ,serum GADA ,IA‐2A ,ICA ,ZnT8A ,insulin ,CP ,glucose , HbA1c ,TG and HDL‐C levels ,which may assist clinic in their classification diagnosis .