OBJECTIVE: To compare the clinical efficacy and complication rates of staged open reduction internal fixation (ORIF) and external fixation combined with limited internal fixation (EFLIF) in the treatment of high-energy Pilon fractures. METHODS: A retrospective selection was conducted on 78 patients diagnosed with high-energy tibial Pilon fractures who received treatment between January 2021 and October 2023. These patients were categorized into the staged ORIF group and the EFLIF group according to their respective treatment protocols. The staged ORIF group comprised 48 patients, including 29 males and 19 females, aged from 33 to 53 years old with a mean age of (43.25±4.67) years old. The time from injury to treatment averaged (6.54±2.21) hours. All patients received staged ORIF treatment. The EFLIF Group consisted of 30 patients, including 18 males and 12 females, aged from 36 to 54 years old with a mean age of (43.37±3.24) years old. The time from injury to treatment averaged (6.87±1.96) hours. All patients received EFLIF treatment. The recovery of ankle joint function, fracture reduction quality, fracture healing time, and surgical-related indicators between two groups were observed and compared six months after surgery. Additionally, the postoperative complications of the two groups were recorded. RESULTS: Both groups of patients were followed up and the duration ranged from 6 to 12 months, with an average of (8.97±1.26) months. At 6-month postoperative follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) score in the ORIF group was (83.15±20.93), which did not show a statistically significant difference compared to the EFLIF group (81.88±20.67), P>0.05. The excellent and good rate of fracture reduction in the staged ORIF group was 33.33% (16/48), which did not show a statistically significant difference compared to the EFLIF group (30.00%, 9/30), P>0.05. The hospitalization duration and fracture healing time in the staged ORIF group were (16.57±1.25) days and (12.14±1.15) weeks, respectively. When compared to the EFLIF group, which demonstrated a hospitalization duration of (15.97±2.16 ) days and a fracture healing time of (12.36±1.17) weeks, no statistically significant differences were observed (P>0.05). The intraoperative blood loss in the staged ORIF group was (76.54±11.65) ml, which was significantly higher than that in the EFLIF group (70.15±10.29) ml, and the difference was statistically significant (P<0.05). The incidence of superficial tissue infection was 2.08%(1/48), which was significantly lower than that observed in the EFLIF group at 16.67% (5/30), and this difference was statistically significant (P<0.05). CONCLUSION Both staged ORIF and EFLIF were effective treatment options for high-energy closed Pilon fractures of the tibia. However, regarding the prevention of superficial tissue infection, staged ORIF demonstrates superior risk control compared to EFLIF.
Humans ; Male ; Female ; Middle Aged ; Adult ; Tibial Fractures/physiopathology* ; Fracture Fixation, Internal/methods* ; Retrospective Studies ; External Fixators ; Open Fracture Reduction/methods* ; Treatment Outcome

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Objective To analyze the infection and drug resistance of Ureaplasma urealyticum(UU),Mycoplasma hominis(MH)and Chlamydia trachomatis(CT)in 2324 patients,and to provide reference for the prevention and treatment of nongonococcal infections in urogenital tract.Methods A retrospective analysis was conducted on the clinical data of 2324 patients diagnosed and treated at Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School from February 2021 to April 2022.UU and MH were detected by liquid culture method and drug sensitivity tests were carried out,and CT was detected by latex method,and the results were statistically analyzed.Results A total of 1006 positive patients were detected,with a total positive rate of 43.3％.The positive rate in female patients significantly higher than that in male patients(x2=68.888,P＜0.001).Among them,the positive detection rates of UU,MH and CT were 40.8％,10.0％and 1.8％respectively.Among patients with single infection,the UU positive detection rate was the highest(31.8％).The positive rate of UU in female patients was significantly higher than that in male patients(x2=70.417,P＜0.001).Among patients with mixed infections,the positive detection rate of UU+MH was the highest(8.2％).The age groups with the highest positive rates of UU,MH and CT were 41-50 years old,≤ 20 years old and 21-30 years old respectively.Results of drug sensitivity test showed that mycoplasma were highly sensitive to doxycycline,minocycline and josamycin,with the sensitivity rates of 97.2％,96.9％and 95.4％respectively.Conclusion Young and middle-aged people are the main population with nongonococcal infection in urogenital tract.UU is the main pathogen detected,and the detection rate of female is higher than that of male.According to the drug sensitivity results of mycoplasma,it is suggested to choose doxycycline,minocycline and josamycin for treatment.

Objective To analyze the infection and drug resistance of Ureaplasma urealyticum(UU),Mycoplasma hominis(MH)and Chlamydia trachomatis(CT)in 2324 patients,and to provide reference for the prevention and treatment of nongonococcal infections in urogenital tract.Methods A retrospective analysis was conducted on the clinical data of 2324 patients diagnosed and treated at Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School from February 2021 to April 2022.UU and MH were detected by liquid culture method and drug sensitivity tests were carried out,and CT was detected by latex method,and the results were statistically analyzed.Results A total of 1006 positive patients were detected,with a total positive rate of 43.3％.The positive rate in female patients significantly higher than that in male patients(x2=68.888,P＜0.001).Among them,the positive detection rates of UU,MH and CT were 40.8％,10.0％and 1.8％respectively.Among patients with single infection,the UU positive detection rate was the highest(31.8％).The positive rate of UU in female patients was significantly higher than that in male patients(x2=70.417,P＜0.001).Among patients with mixed infections,the positive detection rate of UU+MH was the highest(8.2％).The age groups with the highest positive rates of UU,MH and CT were 41-50 years old,≤ 20 years old and 21-30 years old respectively.Results of drug sensitivity test showed that mycoplasma were highly sensitive to doxycycline,minocycline and josamycin,with the sensitivity rates of 97.2％,96.9％and 95.4％respectively.Conclusion Young and middle-aged people are the main population with nongonococcal infection in urogenital tract.UU is the main pathogen detected,and the detection rate of female is higher than that of male.According to the drug sensitivity results of mycoplasma,it is suggested to choose doxycycline,minocycline and josamycin for treatment.

With the popularization of transplantation technology, an increasing number of end-stage organ failure patients are undergoing transplantation surgery, and most of these patients need further monitoring and treatment in the department of critical care medicine. Due to immune suppression in transplant patients, the risk of hospital acquired infection is significantly increased. Therefore, for these patients, it is necessary to implement more stringent bundled management measures for the prevention of ventilator-associated pneumonia, catheter-related bloodstream infections, catheter-related urinary tract infections, and surgical site infections. At the same time, stricter institutional and personnel management is needed. This article, taking into account the guideline recommendations and the experience of our center, focuses on the prevention of hospital acquired infection in organ transplant patients, in order to provide reference for clinical practice of critical care medicine.

Objective:To assess the clinical effect and safety of comprehensive therapy of traditional Chinese medicine(TCM)in the treatment of erectile dysfunction(ED)with damp-heat stasis.Methods:We selected 108 cases of ED with damp-heat stasis meeting the inclusion criteria and treated with tadalafil(the control group,n=54)or tadalafil+comprehensive TCM therapy(the trial group,n=54)in the First Affiliated Hospital of Henan University of Chinese Medicine in the same period.After 8 weeks of treatment,we recorded the patients'scores on IIEF-5,TCM syndrome,erectile quality(EQS),9-Item Patient Health Questionnaire(PHQ-9)and Generalized Anxiety Scale 7(GAD-7).At 16 weeks of our study,we collected the efficacy parameters,safety indicators and adverse reactions by telephone follow-up and compared the data obtained between the two groups of patients.Results:Totally,103 of the patients completed the study,51 in the control and 52 in the trial group.Compared with the baseline,the IIEF-5 and EQS scores were both markedly increased after 8 weeks of treatment in the trial group(12.35±3.00 vs 18.36±2.82,P＜0.05;39.5[30.25-43]vs 67.5[54.5-76.75],P＜0.05)and the control(11.96±2.79 vs 15.88±3.86,P＜0.05;38.0[29-42]vs 56[49-64],P＜0.05),even more significantly in the former than in the latter(P＜0.05);the TCM syndrome and GAD-7 scores were remarkably decreased in the trial(9.5[8-12]vs 4.0[2.25-5],P＜0.05;5[2.25-6.75]vs 2.5[1-4.75],P＜0.05)and the control group(10.0[8-12]vs 5.0[3-6],P＜0.05;5.0[3-6]vs 4.0[2-5],P＜0.05),even more signif-icantly in the former than in the latter(P＜0.05),so were the PHQ-9 scores(P＜0.05),but with no statistically significant differ-ence between the two groups(P＞0.05).The IIEF-5 scores of the two groups remained significantly higher than the baseline during the follow-up(P＜0.05),even higher in the trial than in the control group(17.04±2.60 vs 14.16±3.34,P＜0.05).No obvious abnormal safety indicators or adverse events were observed during the study.Conclusion:Comprehensive TCM therapy combined with tadalafil is superior to tadalafil alone in the treatment of ED with damp-heat stasis,and has a better long-term efficacy and a higher safety.

Objective:To systematically evaluate the effect and safety of electroacupuncture in the treatment of chronic prostati-tis/chronic pelvic pain syndrome(CP/CPPS).Methods:We searched the major Chinese and English databases of CNKI,Wan-fang Data,VIP,CBM,PubMed,Cochrane Library,Web of Science and Embase for randomized controlled trials(RCT)on electroa-cupuncture or combination therapy in the treatment of CP/CPPS published from the establishment of the databases to August 2024.The dichotomous data and continuous data were represented by risk ratio(RR)and mean difference(MD)respectively,both with 95％confidence interval(CI).We analyzed the data with the Revman(v.5.4)software and assessed the quality of the evidence in each RCT using the Grading of Recommendations Assessment,Development and Evaluation system(GRADE).Results:Totally 17 RCTs were identified,involving 1 404 cases of CP/CPPS treated by electroacupuncture or combination of electroacupuncture with medication or with other therapies(the trial group)or by medication with Western or Chinese drugs alone(the control group).Compared with the control group,the trial group showed a significantly higher rate of clinical effectiveness(RR=1.25;95％CI:1.18-1.32;P＜0.05),decreased CPSI scores(MD=-4.56;95％CI:-5.01--4.11;P＜0.05),improved CPSI-pain,-urination and-quali-ty of life scores,and increased maximum and average urinary flow rates.And electroacupuncture did not increase the likelihood of ad-verse reactions.Conclusion:Medium-quality evidence suggests that electroacupuncture is beneficial complementary and alternative therapy for CP/CPPS,with a significant advantage in improving the NIH-CPSI scores of the patients.However,more high-quality multi-centered RCTs with larger sample sizes are still needed to further verify the effect of electroacupuncture on CP/CPPS.

Objective:To explore the role of c-Jun N-terminal kinase (JNK) /c-Jun signaling pathway mediated by endoplasmic reticulum stress in triptolide-induced apoptosis of melanoma A375 cells.Methods:Nude mice were subcutaneously inoculated with melanoma A375 cells on the back to establish the animal model of melanoma. Tumor formation could be observed at approximately 3 weeks after inoculation, and then the mice were divided into 4 groups (4 mice in each group) : control group (injected with sodium chloride physiological solution via the tail vein), 0.1-, 0.2-, and 0.4-mg/kg triptolide groups (injected with 0.1, 0.2, and 0.4 mg/kg triptolide via the tail vein, respectively). Injections were performed twice a week. After 3 weeks of injections, tumors were resected, and their size and weight were measured. The apoptosis levels of tumor xenografts were detected by the terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling (TUNEL) assay. qPCR was conducted to determine the mRNA expression of inositol-requiring enzyme 1 (IRE1), JNK, and c-Jun, and Western blot analysis to determine the protein expression of IRE1, JNK, c-Jun, phosphorylated-JNK (p-JNK), and phosphorylated-c-Jun (p-c-Jun). Comparisons among multiple groups were performed using one-way analysis of variance, and multiple comparisons were performed using Dunnett's test.Results:Significant differences were observed in the tumor mass, volume and tumor suppression rate among the control group, 0.1-, 0.2-, and 0.4-mg/kg triptolide groups (all P < 0.05) ; all the triptolide groups showed significantly decreased tumor masses and volumes (all P < 0.05), but significantly increased tumor suppression rates compared with the control group (all P < 0.05). The tumor apoptosis index significantly differed among the control group, 0.1-, 0.2-, and 0.4-mg/kg triptolide groups (7.67% ± 1.15%, 9.67% ± 3.21%, 62.00% ± 6.08%, and 85.67% ± 5.51%, respectively; F = 305.91, P < 0.001), and the 0.2- and 0.4-mg/kg triptolide groups showed significantly increased tumor apoptosis indices compared with the control group ( t = 17.56, 27.72, respectively, both P < 0.05). qPCR and Western blot analysis revealed significant differences in the mRNA expression of IRE1, JNK, and c-Jun among the control group, 0.1-, 0.2-, and 0.4-mg/kg triptolide groups ( F = 112.23, 27.51, 112.37, respectively, all P < 0.05), as well as in the relative protein expression levels of IRE1, JNK, c-Jun, p-JNK, and p-c-Jun among the above 4 groups (all P < 0.05). Additionally, the 0.4-mg/kg triptolide group showed significantly increased mRNA and protein expression of IRE1, JNK and c-Jun (including p-JNK, p-c-Jun) compared with the control group (all P < 0.05). The mRNA and protein expression levels of IRE1, JNK, and c-Jun in the tumor tissues tended to increase with the rise in drug concentrations, and the protein expression levels of p-JNK and p-c-Jun showed the same trend. Conclusion:Triptolide could activate the JNK/c-Jun signaling pathway mediated by the endoplasmic reticulum stress, and then induce apoptosis of melanoma A375 cells in mice.

Objective:To analyze the histopathological features of primary aldosteronism(PA) based on the histopathology of primary aldosteronism(HISTALDO) consensus classification in patients undergoing unilateral adrenalectomy and explore its correlation with clinical characteristics and postoperative outcomes.Methods:A retrospective study was conducted on 105 unilateral PA patients treated at the First Affiliated Hospital of Nanjing Medical University between April 2017 and April 2022. Postoperative histopathology was classified according to the latest HISTALDO consensus and compared with traditional classifications. Differences in clinical features and primary aldosteronism surgical outcomes(PASO) were analyzed across classifications.Results:HISTALDO classification showed that 67.6% of patients were classical subtype and 32.4% were non-classical subtype. Compared to the non-classical group, the classical group showed lower age, body mass index, serum potassium concentration, fasting blood glucose, HbA 1C, and proportion of CYP11B2 negative nodules as well as higher systolic blood pressure, diastolic blood pressure, prevalence of hypokalemia, and 24-hour urine potassium(all P<0.05). Based on PASO criteria, complete clinical and biochemical success were achieved in 41.7% and 83.3% subjects respectively. A significantly higher proportion of classical group displayed complete clinical and biochemical success than nonclassical group(all P<0.05). Multivariate logistic regression analysis showed that lower serum potassium concentration( OR=0.15, 95% CI 0.03-0.84, P<0.05) and proportion of CYP11B2 negative nodules( OR=0.20, 95% CI 0.05-0.86, P<0.05) were related to classical pathological type, and classical pathological type was independently related to clinical and biochemical remission(all P<0.05). Conclusion:Standardized HISTALDO histopathological classification enhances diagnostic accuracy and predicts postoperative outcomes in unilateral PA, providing a foundation for precise stratified management of PA patients.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.