摘要 目的 探讨孤立性基底节区腔隙性脑梗死早期神经功能恶化（END）的相关影响因素。方法 连续性收集2020年1月—2023年12月就诊于郑州大学人民医院的孤立性基底节区腔隙性脑梗死患者236例，临床资料完整，根据是否出现END将患者分为END组59例及非END组177例，比较患者一般资料，使用多因素二元Logistic回归分析基底节区腔隙性脑梗死患者发生END的影响因素。结果 急性孤立性基底节区腔隙性脑梗死END发生率为25%（59/236），END组病灶累及内囊后肢患者比例、入院NIHSS评分、HbA1c水平、收缩压、女性均高于非END组，两组比较差异有统计学意义（P<0.05）。多因素二元Logistic回归模型分析显示病灶累及内囊后肢（OR=3.167，95%CI 1.305~7.690，P=0.011）是END发生的独立危险因素，HbA1c水平（OR=6.368，95%CI 1.555~26.075，P=0.010）、入院NIHSS评分（OR=2.019，95%CI 1.236~3.299，P=0.005）、收缩压（OR=1.626，95%CI 1.373~1.926，P<0.001）是END发生的相关危险因素。结论 孤立性基底节区腔隙性脑梗死END发生率较高，与病灶累及内囊后肢、入院NIHSS评分高、HbA1c水平升高、收缩压高相关。 Abstract Objective To identify influencing factors for early neurological deterioration （END） in isolated basal ganglia lacunar infarction （iBGLI）. Methods Clinical data were continuously collected from 236 patients with iBGLI confirmed by magnetic resonance imaging between January 2020 and December 2023. The patients were divided into END group （n=59） and non-ED group （n=177） according to the presence or absence of END. General patient information was compared between the two groups， and factors influencing the occurrence of END in patients with iBGLI were identified by multivariate binary logistic regression. Results The incidence of END in acute iBGLI was 25% （59/236）. The percentage of patients with lesions affecting the posterior limb of the internal capsule， admission NIHSS score， HbA1c level， systolic blood pressure， and number of females were significantly higher in the END group than in the non-END group （all P<0.05）. Multivariate binary logistic regression showed that lesions affecting the posterior limb of the internal capsule （odds ratio （OR=3.167，95%CI 1.305~7.690，P=0.011） was an independent risk factor for the development of END，whereas HbA1c level（OR=6.368，95%CI 1.555~26.075，P=0.010）， admission NIHSS score（OR=2.019，95%CI 1.236~3.299， P=0.005）， and systolic blood pressure（OR=1.626，95%CI 1.373~1.926，P<0.001） were associated risk factors for END. Conclusion The higher incidence of END in iBGLI is associated with lesions affecting the posterior limb of the internal capsule， admission NIHSS score， HbA1c level， and systolic blood pressure.
Prognosis

Objective: To identify biomolecular markers closely related to the occurrence of kidney renal clear cell carcinoma (KIRC) and verify their expression levels in clinical samples. Methods: Stage Ⅰ KIRC mRNA sequencing data were obtained from The Cancer Genome Atlas (TCGA).Principal component analysis (PCA) was used for dimensionality reduction to screen differentially expressed genes (DEGs)，which then underwent GO and KEGG analyses.Weighted gene co-expression network analysis (WGCNA) was used to screen genes significantly related to KIRC，and a protein-protein interaction (PPI) network was constructed to screen hub genes.The diagnostic value of hub genes was evaluated with receiver operating characteristic (ROC) curve，and their prognostic value was analyzed using survival curve plots.The correlation between the mRNA expressions of hub genes and the pathological stages of KIRC was analyzed.Clinical samples of 20 patients with stage Ⅰ KIRC treated in our hospital were included，and the expressions of the hub genes in cancerous and adjacent tissues were detected with reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR)，Western blotting，and enzyme-linked immunosorbent assay (ELISA). Results: A total of 8223 DEGs were screened out，including 4092 up-regulated ones and 4131 down-regulated ones.GO analysis showed that DEGs were related to bioadhesion，plasma membrane composition，and transporter activity.KEGG analysis showed that DEGs were related to pathways such as cell adhesion molecules，cytokine-cytokine receptor interactions，and interactions between viral proteins and cytokines and cytokine receptors.WGCNA analysis obtained 171 genes that were significantly related to stage Ⅰ KIRC.The hub gene，lymphocyte cytosolic protein 2 (LCP2)，screened out by the PPI network，was significantly related to stage Ⅰ KIRC.The area under the ROC curve was 0.96.The expression level was negatively correlated with the overall survival rate of patients.The expression of LCP2 was related to the stage and lymph node metastasis.Clinical verification showed that the mRNA and protein relative expressions of LCP2 in KIRC tissues were significantly higher than those in adjacent tissues (P<0.000 1). Conclusion: LCP2 is significantly up-regulated in stage Ⅰ KIRC tissues and can be used as a potential biomarker for the early diagnosis and treatment of KIRC.

Objective To understand the current status of radiation diagnosis and treatment resources and their use in Taiyuan City, China, and provide data support for optimizing resource allocation and standardizing diagnosis and treatment. Methods A census-based approach was implemented using a standardized questionnaire to collect basic information on radiation diagnosis and treatment institutions in Taiyuan City. The number and use frequency of radiation diagnosis and treatment resources were calculated based on the resident population of Taiyuan City at the end of 2023. Results There were a total of 562 radiation diagnosis and treatment institutions in Taiyuan City, with 3970 workers and 1354 pieces of equipment. The numbers of radiation diagnosis and treatment institutions, workers, and equipment per 1 000 000 population were 103, 728, and 248, respectively. There were significant differences in radiation diagnosis and treatment resources among different districts and counties. There were 526 (93.59%) radiation diagnosis and treatment institutions and 25 (96.15%) tertiary hospitals in the six urban districts. All institutions offering nuclear medicine diagnosis and treatment and radiotherapy were located in the urban districts. There were substantial disparities among hospitals of different levels. The average numbers of radiation workers and equipment were in the order of tertiary hospitals (99.42, 17.15) > secondary hospitals (13.31, 4.62) > primary and unrated hospitals (1.43, 1.38). The frequency of radiation diagnosis and treatment in tertiary hospitals was 112 149 per hospital, which is 5 times that of secondary hospitals and 44 times that of primary and unrated hospitals. The use frequency of radiation diagnosis and treatment was 975.79 per 1000 population. The use frequency was 941.12 per 1000 population for X-ray diagnosis, 21.68 per 1000 population for interventional radiology, 8.70 per 1000 population for nuclear medicine diagnosis, 2.33 per 1000 population for nuclear medicine treatment, and 1.95 per 1000 population for radiotherapy. Conclusion There are abundant radiation diagnosis and treatment resources in Taiyuan City. The use frequency of radiation diagnosis and treatment has reached the level of Class II medical and health care regions, and there remains considerable room for growth and improvement. At present, the distribution of radiation diagnosis and treatment resources and services is unbalanced among different districts and counties as well as among institutions of different levels, mainly concentrated in urban districts and tertiary hospitals. The health administrative department needs to make overall plans and allocate resources scientifically.

BACKGROUND:The treatment of distal tibial fractures with soft tissue injury has always been challenging,and the new retrograde tibial nailing is a new choice.Up to now,there were few reports on the biomechanical properties between the new retrograde tibial nailing,anterograde intramedullary nailing and supercutaneous locking plate. OBJECTIVE:To explore the biomechanical stability of new retrograde tibial nailing,antegrade intramedullary nailing and supercutaneous locking plate in the treatment of distal tibial fractures with soft tissue injury using finite element analysis so as to offer a scientific foundation for clinical application. METHODS:The finite element model of transverse distal tibia fracture was established by relevant software utilizing the CT data of the tibia from a 42-year-old healthy male.Retrograde tibial nailing,antegrade intramedullary nailing and supercutaneous locking plate finite element models were assembled under the principle of fracture fixation.Finally,meshing,applying loads,and data processing were accomplished with the ANSYS 2019 software.Moreover,the stress distribution and displacement of the tibia and internal fixation of each model were compared. RESULTS AND CONCLUSION:(1)The displacement of fracture end in the three groups increased with the increase of load.In all mode loads,the average displacement of the fracture end was the least in the retrograde tibial nailing group,followed by the supercutaneous locking plate group,and the highest in the antegrade intramedullary nailing group.At 800 N vertical load,the displacement difference of the fracture end was statistically significant(P<0.05).There was no statistical significance in other load modes.(2)Under different loads,the tibial stress in the three groups was the highest in the middle of the tibia,and gradually decreased to the proximal and distal ends.The stress distribution of the tibial shaft was the highest in the retrograde tibial nailing group,followed by the supercutaneous locking plate group,and the least in the antegrade intramedullary nailing group.(3)Under different loads,the stress of the tibial stress raiser in the three groups was significantly higher in the supercutaneous locking plate group than in the other two groups,with statistical significance(P<0.05).(4)Under different loads,the stress of the fixators in the three groups was the largest in the supercutaneous locking plate group,followed by the retrograde tibial nailing group,and the minimum in the antegrade intramedullary nailing group.There were significant differences in the stress of fixator stress raiser among the three groups under different loading modes(P<0.05).(5)It is indicated that all three fixation methods have the good anti-rotation ability and axial stability.Retrograde tibial nail shows better biomechanical stability.

OBJECTIVE To screen out the pharmacodynamic substances of Cistanches Herba aqueous extracts, explore the basis of the pharmacodynamic substances and their mechanism of action in the treatment of diabetic nephropathy(DN), based on the spectral relationship between the mass spectral peak areas of different elution sites of Cistanches Herba aqueous extracts and their anti-DN effects. METHODS UPLC-Orbitrap-MS/MS technique was used to characterise the chromatographic peaks; MTT method was used to detect the effects of different elution sites of Cistanches Herba aqueous extract on the proliferation of high glucose and high fat HK-2 cells; grey correlation analysis and partial least squares method were used to analyse the spectral relationship between mass spectrometry peak area and anti-DN activity. MTT method was used to determine the anti-DN activities of the individual components of Cistanches Herba aqueous extract; biochemical kit and ELISA were used to determine the levels of oxidative indicators(SOD, GSH-P) and inflammatory factors(IL-1β, TNF-α, TGF-β); Western blotting was used to detect the expression of apoptosis-related proteins. RESULTS UPLC-Orbitrap-MS/MS technique speculated and identified 72 common compounds; In Cistanches Herba aqueous extracts, water, 20% ethanol, and 40% ethanol-eluted sites differentially increased the proliferation rate of HK-2 cells in a high-sugar, high-fat environment; Partial least squares and grey correlation analyses showed that the constituents of the aqueous extracts of Cistanches Herba with greater anti-DN contributions were 8-epideoxymatricinic acid, geniposidic acid, pinoresinol, betaine and syringin, et al. MTT assay reveals that 8-epi-deoxystrychnic acid and geniposidic acid had significant proliferative effects on HK-2 cells in a high glucose and high fat environment; Biochemical kit and ELISA showed that 8-epideoxystrychnic acid and geniposidic acid were able to up-regulate the activity of SOD and GSH-Px, and at the same time they had an inhibitory effect on the expression of inflammatory factors IL-1β, TNF-α and TGF-β. Western blotting results showed that 8-epideoxystrychnic acid and geniposidic acid were able to down-regulate and up-regulate the markers of dermal mesenchymal transition: α-SMA, Collagen Ⅰ and E-cadherin, and they could exert anti-DN effects by inhibiting the PI3K-Akt pathway. CONCLUSION The two compounds, 8-epideoxystrychnic acid and geniposidic acid, which are screened by the spectroeffective relationship of anti-DN among the many chemical constituents contained in Cistanches Herba, can affect oxidative stress, inflammation and epithelial-mesenchymal transformation of renal tubular cells by inhibiting the PI3K-Akt signalling pathway, and improve renal pathology, degree of fibrosis and renal function, which will be useful for the in-depth study of aqueous extracts of Cistanches Herba in the treatment of DN.

ObjectiveTo describe the epidemic characteristics of COVID-19 after policy adjustment from “Category B notifiable disease with category A management” to “Category B notifiable disease with category B management”， and to explore the protective effect of previous infection with SARS-CoV-2 on common symptoms of reinfection. MethodsHealthcare workers infected with SARS-CoV-2 in a grade A tertiary hospital in Shanghai were included in the study from December 4， 2022 to January 11， 2023. Data on demographic characteristics， clinical symptoms， medical history， and COVID-19 vaccination history were collected. We determined the epidemiological curve and characteristics， and then compared the difference in the severity of clinical symptoms between primary and reinfection subjects. ResultsA total of 2 704 cases were included in the study， of which 45 had reinfection， 605 （22.4%）were males， 608 （22.5%）were doctors， 1 275 （47.2%） were nurses， and 2 351 （86.9%） received ≥3 doses of COVID-19 vaccination. The average age of these healthcare workers was （34.9±9.1） years old. The number of cases with mild/moderate illness， asymptomatic infection， fever， headache， dry cough， expectoration， and chest tightness were 2 704 （100.0%）， 92 （3.4%）， 2 385 （88.2%）， 2 066 （76.4%）， 1 642 （60.7%）， 1 807 （66.8%）， and 439 （16.2%）， respectively. Reinfection was a protective factor for fever （OR=0.161， P<0.001）， headache （OR=0.320， P<0.001）， and peak body temperature （β=-0.446， P<0.001）. ConclusionFollowing the COVID-19 policy adjustment as a category B notifiable disease， healthcare workers at a grade A tertiary hospital in Shanghai predominantly experiences mild to moderate COVID-19 symptoms. Reinfection results in milder clinical manifestations， with a lower proportion of being asymptomatic.

BACKGROUND:Most of the studies on combined orthodontic-orthognathic treatment of skeletal class Ⅲ malocclusions have focused on the improvement of the patient's lateral appearance and recovery in the later stages of the treatment,while there are fewer studies observing the microcosmic nature of the alveolar bone remodeling of the lower anterior teeth. OBJECTIVE:To evaluate the therapeutic effect of lower anterior tooth decompensation and alveolar bone remodeling in patients with skeletal class Ⅲ malocclusion before and after orthodontic-orthognathic treatment based on oral X-ray lateral films and oral cone-beam CT. METHODS:From January 2015 to May 2023,15 patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgery at Qingdao Hospital of Rehabilitation University were enrolled.All patients underwent lateral cephalography and cone beam computed tomography before and after treatment.Cephalometric measurement items related to the angle and line distance,lip/lingual bone cracking length(d-La/d-Li)and bone cracking/bone fenestration of the lower anterior teeth before and after treatment were measured. RESULTS AND CONCLUSION:Lateral X-ray films showed that the amount of alveolar bone remodeling after decompensation of the lower anterior teeth showed significant changes compared to before treatment.The root of the tooth moved significantly towards the center of the alveolar bone,and the specific data was closer to normal data,but there were still some differences compared with normal individuals.Based on the cone-beam CT measurement,the bone cracking/bone fenestration length and width of the alveolar bone were improved in almost all the teeth after orthodontic-orthognathic combined treatment,alveolar bone remodeling in some teeth even reached the level of healthy individuals.Before treatment,most patients often experienced bone fenestration/cracking on the lip/lingual side of the lower incisor due to compensatory tooth growth.However,during the preoperative orthodontic stage,decompensation triggered alveolar bone remodeling and significant changes in tooth angle.Preoperative orthodontic treatment caused the upper anterior teeth to retract and the lower anterior teeth to tilt and control the root,but the amount of decompensation before surgery was often insufficient.In the orthognathic surgery stage,the jaw was removed through the positioning guide plate,the maxilla moved forward,and the mandible retreated.During the postoperative orthodontic process,the effect of fine adjustment was better.Although there is a certain degree of recurrence trend in the position of teeth and jawbones,the postoperative orthodontic treatment is closer to the normal value.

BACKGROUND:The treatment of distal tibial comminuted fractures with soft tissue injury has always been challenging.The new retrograde tibial nailing and supercutaneous locking plate are important treatment methods,but their strain and stress shielding at the fracture end during different periods of fracture healing and different load conditions have not been reported. OBJECTIVE:To explore the biomechanical stability of retrograde tibial nailing and supercutaneous locking plate in different periods of fracture healing by finite element analysis to offer a scientific foundation for clinical application and rehabilitation exercise. METHODS:The finite element model of distal tibial comminuted fracture was established by utilizing the CT data of the tibia from a 40-year-old healthy male.Retrograde tibial nailing,supercutaneous locking plate,and callus models were assembled in accordance with the principle of fracture fixation.The finite element analysis was performed using ANSYS software to compare the displacement of the fracture end,the stress shielding of the tibia,the stress of the callus,and the stress distribution of the tibia and the fixation device during different periods of fracture healing. RESULTS AND CONCLUSION:(1)The relative displacement of the tibial fracture decreased gradually with the healing of the fracture,and the displacement decreased significantly after 3 months.At 0 and 1 months after operation,the vertical displacement and total displacement of the supercutaneous locking plate group were higher than those in the retrograde intramedullary nail group.The Z-axis displacement(horizontal medial and lateral displacement)of the two fixation methods was more obvious than the X-axis and Y-axis,and the Z-axis displacement of supercutaneous locking plate group was the most obvious.The maximum Z-axis displacement of the two fixation methods was located on the outside of the tibia,and the minimum displacement was located on the inside of the tibia.(2)The stress shielding rate at different periods of fracture healing gradually decreased with time.The stress shielding rate of the retrograde intramedullary nail was higher than that of the supercutaneous locking plate at different stages of fracture healing.After 3 months,the stress shielding rate of the supercutaneous locking plate was reduced to about 4%,and the stress shielding rate of the retrograde intramedullary nail was reduced to about 40%.(3)The stress of the stress concentration site of the callus in the two fixation methods increased with the increase of the load,and the stress of the callus in the supercutaneous locking plate group was always greater than that in the retrograde intramedullary nail group.The maximum stress distribution of the callus was approximately equally distributed among the two modes of fixation,both in the lateral portion of the tibia.(4)As the fracture healed,the maximum stress of the tibia in the two groups decreased gradually,and the stress in the supercutaneous locking plate group was always greater than that in the retrograde intramedullary nail group.The average stress of the maximum stress area of the tibia in the supercutaneous locking plate group under 1 500 N load was 285 MPa,while that in the retrograde intramedullary nail group was 26 MPa.(5)As the fracture healed,the stress of the fixation device in the two groups decreased gradually,and the stress in the supercutaneous locking plate group was significantly higher than that in the retrograde intramedullary nail group.After 3 months,the stress of the two fixation devices decreased significantly.(6)It is indicated that in the early stage of fracture healing,the strain on the fracture end in the retrograde intramedullary nail group is small,and the maximum stress of the tibia is moderate,allowing early loaded.The fractured ends in the supercutaneous locking plate group had too large strain and too large maximum stress of the tibia,which needed to be partially loaded under protection and could not be fully loaded.In the middle and late stages of fracture healing,the tibial retrograde intramedullary nail and the supercutaneous locking plate could be completely loaded,and the stress shielding rate of the supercutaneous locking plate was significantly lower than the tibial retrograde intramedullary nail.

Objective To investigate the effects of harmine(HM)on the expression level of mitochondrion fusion related proteins and mitochondrial function injury in PC 12 cells.Methods PC 12 cells were divided into cell control group,HM group,mitochondrion mitosis inhibitor Mdivi-1 group,HM+Mdivi-1 group,mitochondrion fission agonist WY14643 group,HM+WY14643 group,with drug concentrations of 1,10,25,50,100 μmol·L-1.After 24 h treatment,the MTT method was used to detect the cell survival rate,and a microscope was used to observe the cell morphology,MitoTracker Red probe staining was used to observe the mitochondrial morphology and the length ratio of vertical and horizontal axes,JC-1 staining was used to detect the mitochondrial membrane potential,and a kit was used to detect ATP level and lactate dehydrogenase(LDH)activity.Immunofluorescence staining and Western blotting were used to assess the expression levels of caspase-3,apoptosis-promoting protein(Bax)cytochrome C(cyt-c),mitochondrial fusion protein(Mfn2)and mitochondrial mitotic protein(Drp-1).The interference sequence of Drp1 was transfected by electroporation,and the siRNA sequence with good transfection effect was screened.The related indicators were detected by fluorescence method,MTT method,and immunoblotting method in cooperation with drug intervention.Results MTT results showed that compared with the cell control group,the survival rate of HM group,Mdivi-1 group,HM+Mdivi-1 group,WY14643 group and HM+WY14643 group decreased significantly(P＜0.01),and the EC50 were(11.48±2.32),(12.35±1.67),(14.88±2.07),(39.14±3.25),(20.09±1.97),respectively.According to this,subsequent experiments selected 20 μmol·L-1for HM,WY 14643 and HM+WY14643 as working concentrations to construct PC 12 cell model.Microscopic observation and MitoTracker Red probe staining showed that the cell density in the drug group decreased in varying degrees,and a transition from branched to round morphology in the drug-treated groups was observed.The morphology of mitochondria tended to be round,and the ratio of the length of the longitudinal axis to transverse axis was(3.33±0.72)in the cell control group,(2.19±0.58)in the HM group,(2.45±0.44)in Mdivi-1 group,and(1.43±0.62)in HM+Mdivi-1 group,respectively.The results of JC-1 staining showed that compared with the cell control group,the mitochondrial mode potential of the HM group significantly decreased(P＜0.01).ROS significantly increased(P＜0.01)and ATP levels decreased(P＜0.01),and LDH enzyme activity increased(P＜0.01).Immunofluorescence staining and Western blotting results showed that compared with the cell control group,the expression levels of proapoptotic proteins Bax,cytochrome C,and caspase-3 in the HM group were significantly increased(all P＜0.01).Compared with the cell control group,the expression level of mitochondrial fission related protein Drp1 in HM group was significantly higher(P＜0.01).The expression level of mitochondrial fusion related protein Mfn2 significantly decreased(P＜0.01).After specific interference with Drp1 and synergistic intervention with HM,the survival rate of PC 12 cells in each interference group decreased compared to each drug intervention group.The expression of Drp1 and Mfn2 was downregulated,and the differences were statistically significant(P＜0.05 or P＜0.01).Conclusion HM can reduce the mitochoudrial membrane potential and ATP levels by accumulating ROS,there by activating the caspase-3 apoptosis pathway and promoting cell apoptosis.Mitochondrial fusion division may be involved in the damage of PC12 cells caused by HM,initiating apoptosis through the mitochondrial pathway.

Objective To understand the basic information of the number, classification, and distribution of radiation work units in non-medical institutions in Shanxi Province, China, and to analyze the status quo of health management and radiation protection measures for radiation workers, so as to provide a scientific basis for occupational exposure protection in non-medical radiation work units and better protect the occupational health rights and interests of radiation workers. Methods A questionnaire survey was conducted to investigate some non-medical institutions in Shanxi Province. On-site testing was carried out to determine the risk factors for radioactive occupational diseases in the selected non-medical institutions. Results In 220 non-medical institutions, there were 340 radiation devices and 2284 radioactive sources. The rate of individual dose monitoring was 92.7% and the rate of occupational health examination was 87.2%. These devices were equipped with 325 detection instruments for radiation protection, 1316 personal protective equipment, and 730 personal dose alarms. Radiation occupational disease risk factors were investigated in 101 institutions. Conclusion The occupational health management of radiation workers in non-medical institutions in Shanxi Province is generally in line with the national standards. However, there is still a big gap with the level of occupational health management in medical institutions. The health administration departments should clarify the management measures for non-medical institutions and strengthen their supervision and management functions.