This article aims to compare and analyze the biomechanical differences between wing-shaped titanium plates and traditional titanium plates in fixing acetabular anterior column and posterior hemi-transverse (ACPHT) fracture under multiple working conditions using the finite element method. Firstly, four sets of internal fixation models for acetabular ACPHT fractures were established, and the hip joint stress under standing, sitting, forward extension, and abduction conditions was calculated through analysis software. Then, the stress of screws and titanium plates, as well as the stress and displacement of the fracture end face, were analyzed. Research has found that when using wing-shaped titanium plates to fix acetabular ACPHT fractures, the peak stress of screws decreases under all working conditions, while the peak stress of wing-shaped titanium plates decreases under standing and sitting conditions and increases under forward and outward extension conditions. The relative displacement and mean stress of the fracture end face decrease under all working conditions, but the values are higher under forward and outward extension conditions. Wing-shaped titanium plates can reduce the probability of screw fatigue failure when fixing acetabular ACPHT fractures and can bear greater loads under forward and outward extension conditions, improving the mechanical stability of the pelvis. Moreover, the stress on the fracture end surface is more conducive to stimulating fracture healing and promoting bone tissue growth. However, premature forward and outward extension rehabilitation exercises should not be performed.
Titanium ; Bone Plates ; Humans ; Acetabulum/surgery* ; Fracture Fixation, Internal/methods* ; Biomechanical Phenomena ; Finite Element Analysis ; Bone Screws ; Fractures, Bone/surgery* ; Stress, Mechanical ; Working Conditions

Objective To compare the safety of laparoscopic pancreatoduodenectomy(LPD)and open pancreatoduodenectomy(OPD)and analyze the learning curve and safety at different stages of LPD.Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024,and intraoperative and postoperative conditions were compared.The Cumulative Sum(CUSUM)analysis method was used to analyze the technical nodes of the LPD learning curve.Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group(P＞0.05).There was also no significant difference in the incidence rates of pancreatic fistula(grade B and C),delayed gastric emptying,postoperative bleeding,biliary fistula and intra-abdominal infection between the LPD group and the OPD group(P＞0.05).A time series plot of operation time was drawn based on the patient's operation time and surgical sequence,yielding a fitted curve.Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases.The LPD learning curve could be divided into three stages:stage Ⅰ characterized as the initial stage(cases 1 to 17),stage Ⅱ characterized as the stable stage(cases 18 to 24),and stage Ⅲ characterized as the proficient stage(cases 25 to 50).The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ,and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ(P＜0.05).There was no significant difference in the incidence of complications among the three stages(P＞0.05).Conclusion LPD and OPD show no significant differences in indications and safety.The LPD learning curve can be divided into three stages.As the number of surgeries completed increa-ses,the operation time of physicians gradually shortens,and the incidence of complications of patients gradually decreases.

Objective In this study,we analyzed the transcriptome sequences of Kupffer cells exposed to simulated microgravity for 3 d and conducted biological experiments to determine how microgravity initiates apoptosis in Kupffer cells. Methods Rotary cell culture system was used to construct a simulated microgravity model.GO and KEGG analyses were conducted using the DAVID database.GSEA was performed using the R language.The STRING database was used to conduct PPI analysis.qPCR was used to measure the IL1B,TNFA,CASP3,CASP9,and BCL2L11 mRNA expressions.Western Blotting was performed to detect the level of proteins CASP3 and CASP 9.Flow cytometry was used to detect apoptosis and mitochondrial membrane cells.Transmission electron microscopy was used to detect changes in the ultrastructure of Kupffer cells. Results Transcriptome Sequencing indicated that simulated microgravity affected apoptosis and the inflammatory state of Kupffer cells.Simulated microgravity improved the CASP3,CASP9,and BCL2L11 expressions in Kupffer cells.Annexin-V/PI and JC-1 assays showed that simulated microgravity promoted apoptosis in Kupffer cells.Simulated microgravity causes M1 polarization in Kupffer cells. Conclusion Our study found that simulated microgravity facilitated the apoptosis of Kupffer cells through the mitochondrial pathway and activated Kupffer cells into M1 polarization,which can secrete TNFA to promote apoptosis.

Objective:To evaluate the effects of Huoxue Bushen Formula Granules on endometrial receptivity (ER) in patients with polycystic ovary syndrome (PCOS) in ovulation induction cycle.Methods:A randomized controlled trial was conducted. Totally 50 patients with PCOS infertility in Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2019 to January 2023 were selected as the observation objects, and were divided into observation group (29 cases) and control group (21 cases) according to the random number table method. Both groups were given oral clomiphene citrate on the 5th day of menstrual cycle or progesterone withdrawal. On this basis, the observation group was given Huoxue Bushen Formula Granules on the 5th day of menstruation, while the control group was given estradiol valerate tablets. 7 days after taking medication and injecting hCG from the 10th day of menstruation, ovulation was monitored and sexual intercourse was guided. Both groups were treated for 3 menstrual cycles and followed up for 3 months. B-ultrasound was performed on 6-8 days after ovulation to obtain uterine artery pulsatility index (PI) and blood flow resistance index (RI). TCM syndrome scores were evaluated before and after treatment, and the endometrial receptivity score (Salle score) was used to evaluate the level of ER. The pregnancy and adverse reactions during treatment were recorded in the two groups.Results:After treatment, TCM syndrome score in the observation group [14.0 (13.0, 15.0) vs. 16.0 (14.5, 19.5), Z=-3.23] was lower than that of the control group ( P<0.001). The Salle score of the observation group after treatment [12.0 (9.5.0, 13.5) vs. 10.0 (9.0, 11.0), Z=-3.84] was higher than that before treatment ( P<0.001). The PI (0.68±0.52 vs. 0.81±0.06, t=18.25), RI (1.65±0.36 vs. 2.24±0.45, t=22.78) after treatment in the observation group and the control group were lower than those before treatment ( P<0.001), without statistical significance ( t values were -0.39, -1.37, respectively, P>0.05). The total effective rate of the observation group was 75.86% (22/29), and that of the control group was 71.43% (15/21), without statistical significance ( χ2=0.12, P=0.724). The pregnancy rate of the observation group was 82.76% (24/29), and that of the control group was 57.14% (12/21), with statistical significance ( χ2=3.96, P=0.046). The incidence of adverse reactions of the observation group was 3.45% (1/29) and that of the control group was 9.52% (2/21), without statistical significance ( χ2=0.80, P=0.372). Conclusion:Huoxue Bushen Formula Granules can improve the ER of PCOS infertility patients with kidney deficiency and blood stasis syndrome, improve the pregnancy rate, reduce the TCM syndrome score, improve the quality of life of patients with high safety.

Objective To investigate the occupational health status of 450 radiation workers in a steel mill when they resigned, and to provide references and suggestions for the occupational health monitoring of the enterprise employees and for the workers’ proper arrangement after their resignations. Methods Occupational health examinations were performedon 450 steel workers who were about to resign in accordance with the applicable laws and regulations. And the examination results were statistically analyzed. Results Among the 450 radiation workers, 82% had abnormal examination results which included chromosome aberration in peripheral blood lymphocytes (4.89%), lens opacity (44.44%), pinguecula (25.33%), hypertension (28.22%), thyroid dysfunction (9.59%), and abnormal liver ultrasound findings (30.89%). Compared with the normal population, these steel workers had a significantly higher chromosome aberration rate in peripheral blood lymphocytes and a significantly higher incidence rate of ocular disorders. Conclusion It is important to effectively manage the occupational health of radiation employees in steel mills, and to regularly provide training on occupational health protection. To avoid radiation damage, workers should pay close attention to radiation protection at work, especially eye protection, to avoid eye disorders.

Objective:To report a case of developmental epileptic encephalopathy caused by CACNA1E gene mutation and explore C Clinical phenotype and prognosis of 2069G>A (p.Gly690Asp) locus.Methods:The clinical data and follow-up of a case of developmental epilepsy related to CACNA1E gene mutation admitted to the Maternity And Children Health Hospital of Xiangtan City in September 2020 were summarized and analyzed.Results:The male patient, with delayed intellectual and motor development, sought medical attention and gradually developed seizures. The genetic results showed that the CACNA1E gene c. 2069G>A (p.Gly690Asp) was a newly discovered variant, and the parental site was a wild-type. Based on clinical manifestations, the diagnosis was a pathogenic variant.Conclusions:Developmental epileptic encephalopathy caused by mutations in the CACNA1E gene can have intellectual and motor impairments as the initial manifestation; Site C 2069G>A (p.Gly690Asp) presents with severe epilepsy and poor prognosis, with the possibility of brain atrophy. The combination of valproic acid and clonazepam may be effective in treating epilepsy.

Objective:To analyze the characteristics of local histological damage in patients with Mycobacterium abscessus infection caused by facial drug injection, and propose a treatment. Methods:The patients of Mycobacterium abscessus infection caused by facial injection of unknown drugs ( "osteolytic needles" ) admitted to Shaanxi Provincial People’s Hospital from September 2021 to June 2022 were analyzed retrospectively. Secretions were collected from the infected site for smear examination before surgery, and perform ultrasound, CT, MRI, and other related examinations. Surgical debridement was performed on the infected site under the assistance of endoscope and the guidance of B-ultrasound. During the operation, the infection was demonstrated to affect the facial superficial musculoaponeurotic system, even the deep muscle and bone tissue. The necrotic and degenerative tissue was completely removed and then the secretion was sent to bacterial culture and drug susceptible test, and the resected tissue was sent to pathological examination for HE staining. After debridement, the wound was not sutured. The vacuum sealing drainage (VSD) technique was used to treat the wound. The cavity was irrigated with 50 ml of normal saline+ 100 000 U of amikacin, and the wound was sutured after the wound was completely healthy and the secretion culture was negative. Drug treatment: first, according to the results of secretion smear examination (positive acid-fast bacteria), empirically apply cefoxitin or amikacin injection. After the infection was confirmed by bacterial culture, oral clarithromycin and minocycline were added, and bicyclol tablets were orally administered to protect liver function. Intravenous drip of cefoxitin or amikacin injection during hospitalization according to the results of drug susceptible test. After discharge, clarithromycin or minocycline and bicyclol tablets were used for 3-6 months, and the blood routine test and liver and kidney functions were examined every 2 weeks. Regular outpatient re-examination was carried out to observe whether there is a recurrence of infection and the recovery of facial appearance in the wound. Results:A total of 10 patients were included, including 1 male and 9 females, aged 19-28 years, with an average age of 25.3 years. The clinical manifestations were local redness and swelling in the zygomatic, buccal, periocular, or anterior temporal regions, low skin temperature, skin ulceration, purulent secretions, and palpable induration. CT and MRI results showed varying degrees of swelling and fluid accumulation in facial soft tissues, as well as locally structural and bone destruction. The results of secretion culture showed all patients were infected with Mycobacterium abscessus. Drug susceptible test results: sensitive to minocycline, cefoxitin, amikacin. HE staining showed exudative, proliferative and necrotic lesions, chronic suppurative inflammation and mixed granuloma lesions. Ten patients were hospitalized for 12-28 days, and their facial infections were well controlled. The wound healing was good. After 6 months of follow-up, there was no recurrence of facial infections and their appearance was generally normal. Conclusion:The local tissue damage caused by facial injection of unknown drug Mycobacterium abscessus infection is characterized as multiple layers, multiple sinuses, and bone destruction. Based on external debridement during treatment, drugs that are sensitive to Mycobacterium abscessus and have relatively small adverse reactions can be selected based on drug susceptible test results. Adherence to long-term and standardized treatment can achieve good results.

Objective:To evaluate the effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness.Methods:From November 2017 to April 2022, a retrospective analysis was performed to assess the reserving of pretarsal fullness after the transcutaneous lower blepharoplasty with a skin flap in the Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA. A subciliary incision was made below the ciliary margin and a skin flap was elevated at the surface of pretarsal orbicularis. The muscle was partially split at the position of pretarsal crease, leaving the pretarsal orbicularis oculi muscle and the pretarsal crease intact. Preseptal dissection was proceeded down to the level of arcus marginalis, exposing the orbital fat pads. For patient with tear trough deformity or volume deficiency in the medial cheek, retaining ligament laxity and fat repositioning were routinely performed. The muscle wound was closed edge to edge and the excess skin was excised conservatively. Postoperative complications were recorded. Face-Q scale was used for surgical decision and postoperative satisfaction evaluation. The scores range from 0 to 100, with higher scores indicating less regret the operation or greater satisfaction. The preoperative and postoperative digital photographs were used to evaluate the change of pretarsal fullness.Results:256 patients were included, of whom 233 cases were women and 23 cases were men. The age was (43.0±10.2) years. 24 cases had concomitant lateral canthoplasty due to hypotonia of lower eyelid, 22 had concomitant upper blepharoplasty, and 21 cases had brow lift surgery to correct upper eyelid relaxation. All patients had follow-up for (3.7±4.1) months, most patients were satisfied with the operation results. A total of 211 patients maintained a natural pretarsal fullness postoperatively, with the rate of 82.4%. The Face-Q satisfaction score was (75.8±18.6) and the surgical decision score was (80.3±15.4), indicating that most patients did not regret the operation. Postoperative complications included 8 cases of eyelid bags undercorrection, of whom 4 patients underwent secondary resection. 7 patients experienced infraorbital bulge for the uneven placement of the fat pad, 2 of them required revision surgery. Hematoma occurred in 4 cases and was resolved by hematoma clearance. Other complications included 3 cases of ectropion and 2 cases of minimal tear trough correction. Lower eyelid ectropion was corrected in one case.Conclusion:Reserving the pretarsal fullness in transcutaneous lower eyelid blepharoplasty with a skin flap provides excellent aesthetic results and high patient satisfaction. This technique is simple and effective.

Objective:To analyze the characteristics of local histological damage in patients with Mycobacterium abscessus infection caused by facial drug injection, and propose a treatment. Methods:The patients of Mycobacterium abscessus infection caused by facial injection of unknown drugs ( "osteolytic needles" ) admitted to Shaanxi Provincial People’s Hospital from September 2021 to June 2022 were analyzed retrospectively. Secretions were collected from the infected site for smear examination before surgery, and perform ultrasound, CT, MRI, and other related examinations. Surgical debridement was performed on the infected site under the assistance of endoscope and the guidance of B-ultrasound. During the operation, the infection was demonstrated to affect the facial superficial musculoaponeurotic system, even the deep muscle and bone tissue. The necrotic and degenerative tissue was completely removed and then the secretion was sent to bacterial culture and drug susceptible test, and the resected tissue was sent to pathological examination for HE staining. After debridement, the wound was not sutured. The vacuum sealing drainage (VSD) technique was used to treat the wound. The cavity was irrigated with 50 ml of normal saline+ 100 000 U of amikacin, and the wound was sutured after the wound was completely healthy and the secretion culture was negative. Drug treatment: first, according to the results of secretion smear examination (positive acid-fast bacteria), empirically apply cefoxitin or amikacin injection. After the infection was confirmed by bacterial culture, oral clarithromycin and minocycline were added, and bicyclol tablets were orally administered to protect liver function. Intravenous drip of cefoxitin or amikacin injection during hospitalization according to the results of drug susceptible test. After discharge, clarithromycin or minocycline and bicyclol tablets were used for 3-6 months, and the blood routine test and liver and kidney functions were examined every 2 weeks. Regular outpatient re-examination was carried out to observe whether there is a recurrence of infection and the recovery of facial appearance in the wound. Results:A total of 10 patients were included, including 1 male and 9 females, aged 19-28 years, with an average age of 25.3 years. The clinical manifestations were local redness and swelling in the zygomatic, buccal, periocular, or anterior temporal regions, low skin temperature, skin ulceration, purulent secretions, and palpable induration. CT and MRI results showed varying degrees of swelling and fluid accumulation in facial soft tissues, as well as locally structural and bone destruction. The results of secretion culture showed all patients were infected with Mycobacterium abscessus. Drug susceptible test results: sensitive to minocycline, cefoxitin, amikacin. HE staining showed exudative, proliferative and necrotic lesions, chronic suppurative inflammation and mixed granuloma lesions. Ten patients were hospitalized for 12-28 days, and their facial infections were well controlled. The wound healing was good. After 6 months of follow-up, there was no recurrence of facial infections and their appearance was generally normal. Conclusion:The local tissue damage caused by facial injection of unknown drug Mycobacterium abscessus infection is characterized as multiple layers, multiple sinuses, and bone destruction. Based on external debridement during treatment, drugs that are sensitive to Mycobacterium abscessus and have relatively small adverse reactions can be selected based on drug susceptible test results. Adherence to long-term and standardized treatment can achieve good results.

Objective:To evaluate the effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness.Methods:From November 2017 to April 2022, a retrospective analysis was performed to assess the reserving of pretarsal fullness after the transcutaneous lower blepharoplasty with a skin flap in the Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA. A subciliary incision was made below the ciliary margin and a skin flap was elevated at the surface of pretarsal orbicularis. The muscle was partially split at the position of pretarsal crease, leaving the pretarsal orbicularis oculi muscle and the pretarsal crease intact. Preseptal dissection was proceeded down to the level of arcus marginalis, exposing the orbital fat pads. For patient with tear trough deformity or volume deficiency in the medial cheek, retaining ligament laxity and fat repositioning were routinely performed. The muscle wound was closed edge to edge and the excess skin was excised conservatively. Postoperative complications were recorded. Face-Q scale was used for surgical decision and postoperative satisfaction evaluation. The scores range from 0 to 100, with higher scores indicating less regret the operation or greater satisfaction. The preoperative and postoperative digital photographs were used to evaluate the change of pretarsal fullness.Results:256 patients were included, of whom 233 cases were women and 23 cases were men. The age was (43.0±10.2) years. 24 cases had concomitant lateral canthoplasty due to hypotonia of lower eyelid, 22 had concomitant upper blepharoplasty, and 21 cases had brow lift surgery to correct upper eyelid relaxation. All patients had follow-up for (3.7±4.1) months, most patients were satisfied with the operation results. A total of 211 patients maintained a natural pretarsal fullness postoperatively, with the rate of 82.4%. The Face-Q satisfaction score was (75.8±18.6) and the surgical decision score was (80.3±15.4), indicating that most patients did not regret the operation. Postoperative complications included 8 cases of eyelid bags undercorrection, of whom 4 patients underwent secondary resection. 7 patients experienced infraorbital bulge for the uneven placement of the fat pad, 2 of them required revision surgery. Hematoma occurred in 4 cases and was resolved by hematoma clearance. Other complications included 3 cases of ectropion and 2 cases of minimal tear trough correction. Lower eyelid ectropion was corrected in one case.Conclusion:Reserving the pretarsal fullness in transcutaneous lower eyelid blepharoplasty with a skin flap provides excellent aesthetic results and high patient satisfaction. This technique is simple and effective.